Ventricular Duration Map Area as a Valuable and Effective Target for VT Ablation End Point in Ischemic...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Imaging

Background:

• Ventricular tachycardia (VT) in ischemic cardiomyopathy poses significant clinical challenges.
• Identifying the arrhythmogenic substrate is crucial for effective VT ablation.
• Ventricular Electrogram Duration Map (VEDUM) offers a novel approach to visualize prolonged electrograms.

Purpose of the Study:

• To evaluate the prognostic role of the VEDUM area in patients with VT and ischemic cardiomyopathy.
• To assess the impact of VEDUM area ablation on VT recurrence.
• To identify predictors of VT recurrence after ablation.

Main Methods:

• Retrospective analysis of 71 patients with ischemic cardiomyopathy undergoing VT ablation.
• Assessment of the VEDUM area size and percentage ablated during catheter ablation.
• Evaluation of VT recurrence as the primary outcome during a mean follow-up of 24.4 months.

Main Results:

• The mean VEDUM area was 14.6 cm², often visualized in low voltage regions.
• Ablation of at least 50% of the VEDUM area was associated with reduced VT recurrence (HR 0.374).
• Lower arrhythmia-free survival was observed in patients with less than 75% VEDUM area ablation.

Conclusions:

• VEDUM area ablation is a novel and effective target for VT ablation in ischemic cardiomyopathy.
• Complete ablation of the VEDUM area may improve long-term outcomes.
• VT inducibility and VEDUM area ablation percentage are key predictors of VT recurrence.