Targeting Wavefront Discontinuity Lines for Scar-Related Ventricular Tachycardia Ablation: A Novel Functional...

Area of Science:

• Electrophysiology
• Cardiology
• Medical Technology

Background:

• Ventricular tachycardia (VT) critical isthmuses are defined by wavefront discontinuities during baseline rhythm.
• Identifying and targeting these wavefront discontinuities for ablation using electroanatomic mapping is not well-established.

Purpose of the Study:

• To assess electrophysiologic characteristics of automatically projected wavefront discontinuity lines (WADLs).
• To evaluate outcomes of an ablation strategy targeting WADLs in a mixed cohort of VT patients.

Main Methods:

• Analysis of late activation substrate maps from baseline rhythm wavefronts.
• Identification of WADLs using the Carto Extended Early Meets Late module.
• Measurement of WADL proximity to critical VT sites and follow-up for VT recurrence and survival.

Main Results:

• WADLs were identified in 69% of analyzed maps across various etiologies and mapping conditions.
• 73.9% of critical VT sites were within 15 mm of a WADL.
• One-year VT-free survival was 62%, with an estimated 1-year VT recurrence risk of 23%.

Conclusions:

• Automated projection of WADLs is feasible in a majority of VT patients.
• Targeting WADLs for ablation leads to a low rate of VT recurrence at one year.