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Review
. 2025 Aug;52(8):e18010.
doi: 10.1002/mp.18010.

The integration of electroanatomic maps into cardiac radioablation treatment planning: A systematic review

Sarah L Lee  1 , Ian J Gerard  2 , Martin L Bernier  3   4 , Tarek Hijal  2   5 , Gabriela Stroian  1   6 , Neil Kopek  2   5 , Joanne Alfieri  2   5 , Piotr Pater  1   6
Affiliations
Review

The integration of electroanatomic maps into cardiac radioablation treatment planning: A systematic review

Sarah L Lee et al. Med Phys. 2025 Aug.

Abstract

Background: Ventricular tachycardia is a life-threatening cardiac arrhythmia for which radiation therapy is an emerging therapeutic option. Electroanatomic maps (EAMs) are used to define clinical target volumes (CTVs) in cardiac radioablation (CRA) treatment planning. Treatment planning systems are unable to integrate EAM data, thus many different workflows have been developed to guide clinicians in CTV creation.

Purpose: To provide a review of existing CTV definition protocols involving EAM integration for CRA.

Methods: PubMed was searched on January 11, 2024, using appropriate search terms. Results were filtered according to inclusion and exclusion criteria following PRISMA guidelines. Results were manually sorted based on their workflow.

Results: The original literature search resulted in 271 search results, to which two hand-selected articles were added. 85 of the resulting articles met inclusion criteria and did not meet exclusion criteria. The reviewed protocols included side-by-side approaches for EAM integration into the treatment planning workflow as well as software-based protocols. Software-based protocols were further subcategorized based on whether the workflows used commercial or non-commercial software to aid in CTV definition.

Conclusions: There is a strong desire to provide solutions for EAM integration into CRA CTV definition protocols. Although single center-specific approaches exist, there is no standardized workflow to address this problem. As the field of CRA grows, standardized workflows and guidelines will be necessary to perform meaningful analyses and comparisons of data between small data sets and to make recommendations for both technical and therapeutic indications.

Keywords: cardiac radioablation; electroanatomic maps; stereotactic arrhythmia radioablation.

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Conflict of interest statement

The authors do not have any conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
EAMs generated by the CARTO software: (a) Bipolar voltage map, (b) Unipolar voltage map, (c) Local activation time map. Spheres mark points that were of interest from the catheter ablation that these maps were originally created for.
FIGURE 2
FIGURE 2
Graphical explanation of EAM integration categories. In the modified side‐by‐side panel, this is just one example of a possible approach.
FIGURE 3
FIGURE 3
PRISMA diagram for included and excluded articles in this review.
FIGURE 4
FIGURE 4
Mentions of CTV definition workflows using EAMs in literature before January 11, 2024, by workflow type.
FIGURE 5
FIGURE 5
Mentions of CTV definition workflows using EAMs in literature before January 11, 2024, by workflow type and year published.
FIGURE 6
FIGURE 6
CARTO EAM showing a bipolar map of the left ventricle in multiple views: (a) Right anterior oblique view, (b) Left anterior oblique view. Scarred tissue (<0.5 mV) is represented in red, normal tissue (>1.5 mV) is represented in purple.
See this image and copyright information in PMC

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