Combination of High-Density and Coherent Mapping for Ablation of Ventricular Arrhythmia in Patients with Structural
Vanessa Sciacca1, Thomas Fink1, Leonard Bergau1
1Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany.
Insights
This study introduces a new mapping technique for ventricular arrhythmia (VA) ablation in structural heart disease (SHD) patients. The approach significantly reduced arrhythmia burden and improved survival, demonstrating high success rates.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Ventricular arrhythmias (VA) in structural heart disease (SHD) pose significant management challenges.
- Catheter ablation is a key treatment modality, but effective targeting of complex arrhythmias remains difficult.
Purpose of the Study:
- To evaluate a novel mapping approach combining high-density and vector-based mapping for VA ablation in SHD patients.
- To assess the efficacy and safety of this new strategy in achieving non-inducibility and reducing arrhythmia burden.
Main Methods:
- Seventy-four patients with recurrent VA and SHD underwent catheter ablation using high-density mapping.
- Local activation time (LAT) and a novel vector-based mapping algorithm were used to analyze arrhythmia propagation.
- Focal tachycardia and re-entrant mechanisms were targeted based on earliest activation and zones of slow conduction, respectively.
Main Results:
- High success rates were achieved, with 94.6% of patients rendered non-inducible for any VA.
- Successful termination of VA was achieved in 93.5% of patients with stable VA.
- Significant reductions in VA burden, anti-tachycardia pacing (ATP), and shock burden were observed post-ablation, with 85.1% arrhythmia-free survival at 12 months.
Conclusions:
- The combined high-density and coherent mapping approach enhances understanding of tachycardia mechanisms in SHD patients.
- This novel strategy provides effective targets for catheter ablation, leading to improved clinical outcomes and reduced arrhythmia recurrence.
Abstract:
The present study describes our experience with a new mapping approach for ventricular arrhythmia (VA) ablation in patients with structural heart disease (SHD). Consecutive patients undergoing catheter ablation for recurrent VA were analyzed. High-density mapping was conducted in all patients. In patients with inducible VA, local activation time (LAT) mapping and a novel vector-based mapping algorithm were implemented to analyze arrhythmia propagation. In case of focal tachycardia, the location of earliest activation was targeted. In VAs with re-entrant mechanisms, zones of slow conduction based on coherent mapping were ablated. Substrate modification was performed when pathologic electrograms were identified. Seventy-four patients were included. Sixty-five patients (87.8%) were male. Ischemic cardiomyopathy was the underlying disease in 35 patients (47.3%) and nonischemic cardiomyopathy was the underlying disease in 39 patients (52.7%). Mean left ventricular ejection fraction was 33.8 ± 9.9%. Non-inducibility of any VA was achieved in 70 patients (94.6%). Termination of VA was achieved in 93.5% of patients with stable VA. In 4 patients (5.4%), partial success was achieved. VA (p < 0.001), ATP (p < 0.001) and shock burden (p = 0.001) were significantly reduced after ablation. Mean arrhythmia-free survival after 12 months was 85.1 ± 4.7%. High-density mapping in combination with coherent mapping may facilitate the understanding of the tachycardia mechanism, providing targets for effective ablation.
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