Extrastimuli-assisted functional mapping improves ventricular tachycardia ablation outcomes: A systematic review,...

In the context of ventricular tachycardia (VT) ablation, functional electroanatomic mapping techniques may help identify arrhythmogenic substrates in scarred and normal voltage areas. In addition, extrastimuli-assisted (dynamic) mapping may be more effective than intrinsic rhythm (static) approaches to uncover key ablation targets, potentially improving procedure outcomes.

We aimed to assess the efficacy and safety of functional mapping-assisted VT ablation and to compare procedural outcomes between dynamic and static mapping approaches.

PubMed/MEDLINE, Scopus, Web of Science, and Cochrane databases were searched using MeSH terms ventricular tachycardia ablation, functional mapping, recurrence, complications, and similar keywords. Meta-analyses of single proportions, rates, and means were performed, employing random effects models and P < .05. Subgroup analysis and meta-regression were performed.

We included 16 studies, covering 674 patients, with follow-up ranging from 6 to 38.1 ± 29.7 months. Ischemic cause represented 490 (72.7%) patients; left ventricular ejection fraction varied from 25% ± 10% to 41.5% ± 13.8%. Dynamic mapping was used in 9 (57.1%) studies, 6 (37.5%) studies employed static techniques, and 1 (6.3%) study used a mixed approach. Procedure duration (P = .520) and complication incidence (P = .110) were similar between dynamic and static mapping modalities. The dynamic mapping subgroup exhibited significantly lower VT recurrence rate compared with the static mapping population (P < .010). This result persisted on a meta-regression model adjusted for ischemic cause and left ventricular ejection fraction, demonstrating that dynamic functional mapping was independently associated with lower recurrence rates (P = .005).

Functional mapping was demonstrated to be safe for VT ablation. Dynamic functional mapping independently associated with reduced postablation recurrence rates without significantly increasing procedure duration.