MRI-guided Ventricular Tachycardia Ablation in Patients With Structural Heart Disease

Cardiac magnetic resonance imaging (MRI) with late gadolinium enhancement (LGE) can visualize myocardial scar in high detail before the procedure. Dedicated software (ADAS-3D) converts these MRI scans into a patient-specific three-dimensional model of the scar, including the "heterogeneous tissue channels" of surviving muscle within the scar that are the likely source of VT. This model can be integrated into the mapping system during the ablation procedure, potentially allowing operators to identify and treat the critical tissue more precisely.

This prospective, multi-center, single-blind, randomized controlled trial is testing whether adding LGE-MRI guidance to conventional electrical mapping improves the outcomes of VT ablation. Adults aged 18 to 75 years with structural heart disease and documented sustained VT will undergo cardiac MRI screening. Those with visible scar (LGE-positive) will be randomly assigned in a 1:1 ratio to one of two groups: ablation guided by LGE-MRI integrated with electroanatomical mapping (experimental group), or ablation guided by electroanatomical mapping alone without image integration (control group, with operators blinded to the MRI findings). Patients without scar on MRI will be followed in a separate observational registry.

All participants will be monitored in hospital for at least 24 hours after the procedure and will attend clinic visits at 3, 6, and 12 months. VT recurrence will be monitored with wearable smart ECG devices (worn for at least 7 days at each follow-up) and, in patients with an implantable cardioverter-defibrillator (ICD), by device interrogation. The main goal of the study is to determine whether MRI-guided ablation reduces the combined risk of VT recurrence, cardiovascular hospitalization, or death during 12 months of follow-up compared with standard ablation. The study also assesses procedure-related complications.