Substrate mapping and ablation for ventricular tachycardia: the LAVA approach

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Catheter ablation is effective for ventricular tachycardia (VT), especially with frequent defibrillator shocks.
• Optimal endpoints for VT ablation remain debated, prompting research into new strategies.
• Ablation techniques focusing on substrate homogenization for scar-related VT have emerged.

Purpose of the Study:

• To evaluate a novel VT ablation strategy focused on homogenizing the myocardial substrate.
• To assess the feasibility and efficacy of eliminating local abnormal ventricular activity (LAVA) as an ablation endpoint.
• To determine the impact of complete LAVA elimination on patient outcomes.

Main Methods:

• Substrate homogenization via local abnormal ventricular activity (LAVA) elimination.
• LAVA identified as high-frequency sharp signals indicating slow conduction and potential VT isthmuses.
• Utilized pacing maneuvers, cardiac MRI, and CT for precise ablation targeting.

Main Results:

• The LAVA elimination strategy is feasible in approximately 70% of scar-related VT patients.
• Complete LAVA elimination is associated with significantly better outcomes compared to LAVA persistence.
• This approach demonstrated improved outcomes even when VT remained non-inducible post-ablation.

Conclusions:

• A simple, effective VT ablation endpoint using LAVA elimination in sinus rhythm.
• High-definition imaging, mapping, and epicardial access enhance this ablation strategy.
• Complete LAVA elimination represents a promising endpoint for scar-related VT ablation.