Epicardial Ventricular Tachycardia Ablation Guided by a Novel High-Resolution Contact Mapping System: A Multicenter...

Background Mapping using a multipolar catheter with small and closely spaced electrodes has been shown to improve the validity of electrograms to identify endocardial critical sites of reentry isthmus and foci of earliest activation. However, the feasibility, safety, and clinical outcome of using such technology to guide epicardial ventricular tachycardia (VT) ablation has not been reported. Methods and Results Thirty-three consecutive patients from 5 high-volume centers were studied. These patients had 43 epicardial maps using a novel 64-pole mini-basket catheter to guide VT ablation. Activation maps with 17 832 points per map (interquartile range: 7621-32 497 points per map) were acquired in 11 patients with tolerated VT (7 focal, 4 reentry). Substrate maps with 40149 points per map (interquartile range: 20926-49391 points per map) were acquired in 30 patients. Local abnormal ventricular activities were consistently demonstrated at the substrate regions of interest. Epicardial ablation was performed in 31 of 33 patients, with acute VT termination in 10 of 11 patients (91%). Complete elimination of local abnormal ventricular activities was achieved in 25 of 31 patients. At a median follow-up of 10 months (interquartile range: 4-14 months), 64% (7/11) of patients who had acute termination of VT and 55% (11/20) of those who had substrate modification alone were free of VT. There was no immediate complication following epicardial procedure. Conclusions Epicardial VT ablation guided by a mini-basket catheter is feasible and safe. Complete reentry VT circuits and foci of earliest activation were identified in all inducible stable VT. The longer term clinical outcome of ablation guided by this novel mapping technology utilizing small and closely spaced electrodes will have to be determined with a larger study.