A Simplified Epicardial Ablation Strategy for Ventricular Tachycardia Integrating CT-Derived Epicardial Adipose Tissue Into Three-Dimensional Electroanatomic Mapping.

INTRODUCTION

Epicardial adipose tissue (EAT) can attenuate electrograms and limit lesion formation during epicardial ventricular tachycardia (VT) ablation.

CASE PRESENTATION: We developed a simplified workflow using predefined CT attenuation values to integrate EAT into the CARTO 3 system. We applied this approach in three patients with dilated cardiomyopathy undergoing epicardial VT ablation, where EAT visualization guided target selection, avoided ineffective ablation, and informed alternative endocardial strategies.

DISCUSSION: EAT-integrated mapping improved the interpretation of epicardial substrates and influenced procedural decision-making. This workflow may facilitate efficient assessment of epicardial ablation feasibility in complex VT cases.