Directed Graph Mapping for Ventricular Tachycardia: A Comparison to Established Mapping Techniques

Area of Science:

• Electrophysiology
• Cardiovascular Medicine
• Medical Technology

Background:

• Successful ventricular tachycardia (VT) ablation requires understanding VT mechanisms and critical circuit components.
• Directed graph mapping (DGM) is a novel technique designed to identify VT mechanisms and circuit components.

Purpose of the Study:

• To evaluate the accuracy of DGM in VT ablation.
• To compare DGM against traditional mapping (TM) and an automated conduction velocity mapping (ACVM) tool.

Main Methods:

• Included patients with structural heart disease undergoing VT ablation with entrainment-proven critical isthmus and high-density electroanatomical mapping.
• Traditional mapping (TM) served as the gold standard.
• Local activation time data were processed using DGM and ACVM for comparison with TM.

Main Results:

• Overall agreement between DGM and TM for VT mechanism and circuit type was strong (kappa = 0.79).
• Agreement between ACVM and TM was also strong (kappa = 0.66).
• Both DGM and ACVM correctly identified the VT isthmus in 89% of re-entrant cases and focal activation in all cases.

Conclusions:

• DGM is a rapid, automated algorithm.
• DGM demonstrates a strong level of agreement with traditional mapping for VT maps.
• DGM shows promise as an effective tool for VT ablation.