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Related Experiment Video

Updated: Jan 23, 2026

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

Joseph Mayer1, Jaffar Al-Sheikhli2, Xuezhe Wang3

  • 1Heart Rhythm Research Group, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom; Institute for Cardio-Metabolic Medicine, University Hospital Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.

JACC. Clinical Electrophysiology
|January 22, 2026
PubMed
Summary
This summary is machine-generated.

Functional extra-stimulus (ES) mapping using electrogram (EGM) duration prolongation DeEP maps accurately identifies ventricular tachycardia substrates. This method is superior to other ES mapping approaches for VT ablation planning.

Keywords:
catheter ablationdecremental evoked potentialsfunctional substrate mappingnear-fieldventricular tachycardia

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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.