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Substrate Mapping for Ventricular Tachycardia: Assumptions and Misconceptions.

Mark E Josephson1, Elad Anter1

  • 1Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

JACC. Clinical Electrophysiology
|May 16, 2018
PubMed
Summary
This summary is machine-generated.

Current substrate mapping for ventricular tachycardia (VT) relies on outdated assumptions. Re-evaluating electroanatomical mapping (EAM) techniques is crucial for accurately characterizing the arrhythmogenic substrate in post-infarction VT.

Keywords:
ablationelectrogrammappingsubstrateventricular tachycardia

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Substrate mapping for infarct-related ventricular tachycardia (VT) is based on 30-year-old data.
  • Traditional electrogram (EGM) characteristics define the arrhythmogenic substrate.
  • Electrophysiological mapping systems have evolved, but underlying assumptions persist.

Purpose of the Study:

  • To critically evaluate the accuracy of current substrate mapping techniques for VT.
  • To identify and challenge common assumptions in VT substrate characterization.
  • To advocate for re-evaluation and standardization of mapping methods.

Main Methods:

  • Review of historical data and current electroanatomical mapping (EAM) principles.
  • Analysis of assumptions regarding scar, voltage amplitude, and isthmus identification.
  • Consideration of recent high-resolution mapping data.

Main Results:

  • Current substrate mapping techniques for VT are based on several unvalidated assumptions.
  • Assumptions include immutable scar barriers, low voltage implying inexcitability, and valid entrainment mapping in all VT types.
  • Recent high-resolution mapping data challenge the validity of these assumptions.

Conclusions:

  • Existing substrate mapping techniques for post-infarction VT require re-evaluation.
  • Higher resolution mapping suggests current methods may inaccurately characterize the arrhythmogenic substrate.
  • Standardization of recording techniques is essential for accurate VT substrate characterization.