InSPACE-VT_Development and Validation of Virtual Pace Mapping to Guide Catheter Ablation of Ventricular Tachycardia

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Wider research context:Ischemic heart disease is the most common cause of death world-wide with ventricular tachycardia (VT) as direct consequence of it. Catheter ablation for VT is an important therapeutic option. Despite advances in ablation tools, procedure times remain high with a relevant risk of complications, whilst success rates are punitively low. The procedure is frequently guided by the identification of exit sites of scar-related slow-conducting isthmuses which provide the reentrant substrate. "Pace mapping" identifies exit sites by matching the surface ECG QRS of catheter-stimulated beats from different myocardial locations with the QRS of the clinical VT.Objectives:We propose the development and clinical validation of virtual mapping as a pre-procedural planning tool to identify critical isthmuses. Our solution aims to reduce catheter ablation procedure times, increase safety, and significantly improve the accuracy of target selection, improving patient care and long-term outcomes.Methods:Advanced CMR protocols will be developed to facilitate the acquisition of scar data at a resolution adequate to create detailed patient-specific models, upon which virtual pace maps will be constructed. This will enable us to perform uncertainty analysis, developing an imperative quantitative understanding of the sensitivity of our virtual predictions to the inputted data and parameters. The developed methodology will later be applied to clinical data collected from 25 VT ablation patients, providing a carefully controlled series of specific tests of our virtual approach.Level of Originality:The suggested studies on how virtual pace-mapping can identify critical isthmuses using clinical data of patients undergoing VT ablation are entirely novel. The suggested study on how virtual pace-mapping can identify critical isthmuses using clinical data of patients undergoing VT ablation have not been entertained previously.