Arrhythmias Clinical Trials

Experimental: Ablation strategy

Ablation is guided by an integrated non-invasive mapping strategy, combining structural targets from late gadolinium enhancement cardiac magnetic resonance and/or functional targets (deceleration zones) from non-invasive Volumetric ECGi in sinus rhythm (SR) and pacing protocol; both are merged with invasive electroanatomic mapping. Before ablation, programmed stimulation assesses VT inducibility; if VT is induced, its Volumetric ECGi-derived critical isthmus is added as a further target. Lesions are delivered to these non-invasively defined target regions, with adequacy defined as loss of local capture on pacing at the ablation site. Afterwards, SR and paced Volumetric ECGi remapping reassesses residual deceleration zones, with further ablation and remapping if substrate persists. Programmed stimulation is repeated, with invasive remapping and ablation for validation. Acute procedural success requires VT non-inducibility and elimination of relevant functional substrate.