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Off-line analysis of electro-anatomical mapping in ventricular arrhythmias
Daniele Muser1, Jackson J Liang1, Pasquale Santangeli2
1Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Insights
Sudden cardiac death from ventricular tachycardia (VT) is a concern. Implantable cardioverter defibrillator (ICD) shocks are a problem, but new imaging and mapping techniques help identify VT causes.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Sudden cardiac death due to ventricular tachycardia (VT) is a significant risk in patients with structural heart disease and reduced ejection fraction.
- While implantable cardioverter defibrillator (ICD) therapy improves survival, frequent ICD shocks negatively impact quality of life and increase mortality.
- Scar-related re-entry, involving surviving myocardial fibers within fibrotic tissue, is the primary mechanism for VT in both ischemic and non-ischemic cardiomyopathies.
Purpose of the Study:
- To review established methods for characterizing the ventricular tachycardia (VT) substrate.
- To explore the application of novel emerging technologies for VT substrate identification.
- To provide insights into substrate-based approaches for preventing and treating VT.
Main Methods:
- Review of established techniques for VT substrate characterization.
- Analysis of data from invasive electroanatomical mapping.
- Inclusion of noninvasive imaging modalities, specifically cardiac magnetic resonance, for arrhythmic substrate identification.
Main Results:
- Scar-related re-entry is the predominant VT mechanism in cardiomyopathies.
- Both invasive mapping and noninvasive imaging aid in understanding VT substrate.
- Established and emerging technologies offer improved VT substrate characterization.
Conclusions:
- Effective VT management requires a substrate-based approach.
- Cardiac magnetic resonance and electroanatomical mapping are crucial for identifying the arrhythmic substrate.
- Emerging technologies hold promise for advancing VT prevention and treatment strategies.
Abstract:
Sudden cardiac death due to ventricular tachycardia (VT) is a major health issue in patients with structural heart disease and depressed ejection fraction. If from one side, implantable cardioverter defibrillator (ICD) therapy has significantly improved survival of these patients, on the other hand, it has led to frequent ICD shocks as an emerging problem, being associated with poor quality of life, frequent hospitalizations and increased mortality. Scar-related re-entry due to the coexistence of surviving myocardial fibers within fibrotic tissue is the most common mechanism subtending VT both in ischemic and non-ischemic cardiomyopathies. In the last two decades, continuous efforts to determine VT mechanisms and effectively prevent and treat VT with a substrate-based approach has benefit from off-line analysis of data coming from invasive electroanatomical mapping as well as from noninvasive imaging modalities such as cardiac magnetic resonance able to identify the arrhythmic substrate. In this review, we walk over again established methods for VT substrate characterization and we present possible applications of new emerging technologies.