Computed Tomography in the Management of Electrophysiology Procedures

Abstract

Cardiac computed tomography (CT) is an established noninvasive imaging technique which provides essential anatomic and functional appraisal prior to electrophysiology procedures in patients with atrial fibrillation (AF), heart failure (HF) undergoing cardiac resynchronization therapy (CRT), and ventricular tachycardia (VT). Modern technological advances have allowed cardiac CT to have a role in pre-procedural planning for invasive electrophysiology procedures such as pulmonary vein isolation (PVI) and left atrial appendage (LAA) occlusion devices in patients with AF, coronary venous imaging in patients undergoing CRT, and myocardial scar detection in patients undergoing substrate mapping for ventricular tachycardia ablation with contraindications to cardiac magnetic resonance imaging (MRI) for scar imaging. This chapter addresses the applications of cardiac CT as a pre-procedural guide to facilitate a variety of electrophysiology procedures in (1) AF patients to anatomically assess the left atrium (LA), LAA, and pulmonary veins (PV) for co-registration with electro-anatomical mapping (EAM), (2) end-stage HF patients who are being considered for CRT to anatomically assess for the coronary venous tree, and (3) VT patients who have contradictions to MRI for myocardial scar assessment but may benefit from CT myocardial scar detection for substrate mapping for VT ablation.