Dynamic High-density Functional Substrate Mapping Improves Outcomes in Ischaemic Ventricular Tachycardia Ablation:
Nikolaos Papageorgiou1, Neil T Srinivasan1,2,3
1Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
Arrhythmia & Electrophysiology Review
|May 3, 2021
Summary
Identifying ventricular tachycardia (VT) triggers is challenging. Functional mapping techniques show promise for improving VT ablation outcomes by pinpointing critical areas for intervention.
Area of Science:
- Cardiovascular Medicine
- Electrophysiology
- Medical Technology
Background:
- Post-infarct ventricular tachycardia (VT) arises from reentry within scar tissue.
- Current VT mapping and ablation face challenges with poorly tolerated, non-sustained, or non-inducible VT.
- Conventional substrate mapping has limitations due to signal ambiguity and varied mapping tools.
Purpose of the Study:
- To address the challenges in mapping and ablating ventricular tachycardia (VT).
- To explore functional substrate mapping techniques for improved VT substrate characterization.
- To enhance the safety, reproducibility, and outcomes of VT ablation procedures.
Main Methods:
- Review of conventional substrate mapping techniques and their limitations.
- Introduction of functional substrate mapping, specifically single extrastimulus protocol mapping.
- Analysis of delayed potentials and their role in sustaining VT.
Main Results:
- Conventional methods show poor real-world outcomes for VT ablation freedom from recurrence.
- Functional mapping identifies regions with unmasked delayed potentials crucial for VT maintenance.
- These dynamic regions are key targets for improving ablation strategies.
Conclusions:
- Functional substrate mapping offers a more dynamic and potentially accurate approach to VT substrate characterization.
- Improved mapping may lead to safer, more reproducible VT ablation and better patient outcomes.
- Large-scale studies are required to validate these findings and refine techniques.
