Multiparametric Electrogram Feature Analysis for Ventricular Tachycardia Functional Extra-Stimulus Substrate Mapping.

Area of Science:

• Electrophysiology
• Cardiac Arrhythmia Research
• Medical Device Technology

Background:

• Functional extra-stimulus (ES) substrate mapping can decrease ventricular tachycardia (VT) recurrence compared to intrinsic rhythm mapping.
• A standardized approach for functional ES mapping is currently lacking.

Purpose of the Study:

• To evaluate the accuracy of various functional ES mapping techniques.
• To assess multiple electrogram (EGM) components for improved VT substrate identification.

Main Methods:

• A multicenter, international VT ablation cohort was analyzed.
• Six functional ES maps were created using offline annotation of EGM components (stimulus artifact, first/last deflection, near-field EGMs).
• Accuracy was tested for identifying the critical arrhythmogenic substrate.

Main Results:

• The EGM duration-based decremental evoked potential (DeEP) map showed the highest accuracy (AUC 0.804 ± 0.107).
• Optimal decrement thresholds were 20 or 30 milliseconds.
• Including latency or automated near-field EGM annotation did not enhance diagnostic performance.

Conclusions:

• Functional ES mapping utilizing EGM duration prolongation DeEP maps is the most accurate method for defining the arrhythmogenic substrate.
• Latency or near-field EGM annotation do not improve functional substrate mapping accuracy.