Ventricular Tachycardia Ablation Using Map Merge Capable of Integrating Multiple Sessions

Area of Science:

• Cardiology
• Electrophysiology
• Medical Technology

Background:

• Cardiac sarcoidosis can cause recurrent ventricular tachycardia (VT).
• Identifying VT substrates in cardiac sarcoidosis often requires both endocardial and epicardial mapping.
• Previous ablation attempts may not fully identify the VT substrate.

Purpose of the Study:

• To present a novel approach for VT ablation in cardiac sarcoidosis using the CARTO 3 Map Merge function.
• To demonstrate the utility of integrating multi-session mapping data for precise ablation targeting.
• To evaluate the efficacy of this approach in preventing VT recurrence.

Main Methods:

• A 62-year-old male with recurrent VT underwent endocardial mapping and ablation.
• Epicardial mapping and ablation were performed due to VT recurrence and suspected epicardial substrate.
• The CARTO 3 Map Merge function was utilized to integrate endocardial and epicardial mapping data.
• Voltage mapping and pace mapping were used to identify low-voltage areas (LVAs) and abnormal potentials.

Main Results:

• Initial endocardial mapping showed no significant LVAs, but pace mapping matched VT.
• Epicardial mapping revealed broad LVAs and late potentials consistent with the endocardial sites.
• Map Merge confirmed spatial consistency between endocardial and epicardial findings, enabling precise ablation targeting.
• No VT recurrence was observed post-ablation.

Conclusions:

• The CARTO 3 Map Merge function is valuable for VT ablation, especially in complex cases like cardiac sarcoidosis with epicardial substrates.
• Integrating data from multiple ablation sessions enhances procedural accuracy and efficiency.
• This approach improves the identification and targeting of VT substrates, potentially leading to better patient outcomes.