Wave Speed Mapping as a Complementary Tool for Identifying Ventricular Tachycardia Substrate

Wave speed (WS) mapping, enabled by omnipolar technology, allows for real-time visualization of local conduction velocity (CV). Its utility in ventricular tachycardia (VT) ablation has not been fully characterized.

We describe a case series of patients undergoing VT ablation in which WS mapping was applied alongside established techniques such as peak frequency (PF) mapping and isochronal late activation mapping (ILAM). WS mapping highlighted regions of high CV and conduction heterogeneity, which partially overlapped with PF and ILAM-defined substrate areas. In some cases, WS mapping revealed broader or discordant zones, suggesting it may capture conduction dynamics not identified by conventional markers. Ablation in WS-identified regions resulted in VT termination or noninducibility. Functional validation techniques (e.g., entrainment) were limited by VT noninducibility or hemodynamic instability.

WS mapping may offer complementary insights into conduction heterogeneity and mismatch within VT substrates. While preliminary and limited by the absence of functional validation, our findings support further investigation of WS mapping as a tool to refine substrate-guided VT ablation strategies.