Advanced Imaging in Interventional Electrophysiology

Interventional electrophysiology is rapidly evolving toward a higher level of safety and precision, ultimately improving procedural outcomes.In the context of electrophysiological procedures, while the evolution of conventional electroanatomic mapping techniques has provided important support, allowing an extremely accurate definition of functional and electrical substrates, a deeper comprehension of anatomical structures may further extend substrate characterization. Fat, fibrosis, scar formation and inflammation are pivotal contributors to the initiation and recurrence of arrhythmias. Computed tomography (CT), magnetic resonance imaging (MRI), intracardiac echocardiography (ICE), and positron emission tomography (PET) have revolutionized the ability to non-invasively and invasively characterize arrhythmic substrates. While these technologies promise to refine diagnosis and ablation targeting, ongoing challenges include inconsistent clinical integration, variability in protocols, and the need for correlation between imaging-derived markers and patient outcomes.Advanced imaging techniques may also contribute to improving outcomes in left atrial appendage closure, resulting in fewer leaks and device displacements, as well as safer procedures.This Research Topic aims to advance the use of advanced imaging modalities to better characterise, guide, and evaluate interventions in patients with cardiac arrhythmias. It seeks to define standardised frameworks for integrating CT, MRI, PET, and ICE into procedural planning, real time monitoring, and post ablation assessment. The ultimate goal is to develop imaging based biomarkers that predict recurrence risk, improve lesion durability, and reduce complications, thereby facilitating more personalised and reproducible treatment. Moreover, this Topic encourages interdisciplinary collaboration between clinicians, imaging scientists, and biomedical engineers to foster translation of emerging technologies into effective clinical workflows.To gather further insights in imaging guided arrhythmia intervention, this Research Topic will explore methodological, mechanistic, and translational aspects, but excludes imaging studies limited to pacing therapies such as conduction system pacing. We welcome articles addressing, but not limited to, the following themes:• Imaging based modelling of atrial and ventricular arrhythmic substrates in atrial fibrillation and ventricular tachycardia• Integration of CT or cardiac MRI with electroanatomic mapping and navigation systems• PET and nuclear imaging approaches for identifying inflammatory or metabolic substrates of arrhythmia• Role of intracardiac echocardiography for real time lesion evaluation and enabling fluoroscopy free workflows• Application of emerging technologies such as photon counting CT, 4D flow MRI, or AI driven image segmentation in procedural planning and guidance• Role of multimodality imaging, particularly intracardiac echocardiography, in left atrial appendage closure procedures Topic editors: Lorenzo Pistelli, GEORGIOS LEVENTOPOULOS Source: https://www.frontiersin.org/research-topics/83581/advanced-imaging-in-interventional-electrophysiology