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The Transmural Activation Interval in Dilated Cardiomyopathy: A New Mapping Tool for Intramural VT Substrates.
Saif Abdel-Kafi1, Sebastiaan R D Piers1, Augusto Meretta1
1Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
JACC. Clinical Electrophysiology
|February 13, 2026
Summary
Transmural activation delay during sinus rhythm effectively identifies the substrate for ventricular tachycardia (VT) in patients with dilated cardiomyopathy (DCM). This novel mapping tool aids in pinpointing VT ablation sites within the intramural substrate.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Dilated cardiomyopathy (DCM) often presents with ventricular tachycardia (VT) originating from deep intramural substrates.
- Identifying these intramural substrates is crucial for successful VT ablation.
Purpose of the Study:
- To determine if transmural activation during sinus rhythm can identify VT substrates in nonischemic DCM.
- To evaluate the efficacy of transmural activation interval (TAI) in mapping these substrates.
Main Methods:
- Electrophysiological mapping was performed in DCM patients undergoing VT ablation.
- Transmural activation interval (TAI) was calculated, and transmural activation delay (TAD) was defined.
- The spatial relationship of critical isthmus sites (CIS) and VT-related sites (VRS) to areas with TAD, late gadolinium enhancement, and low unipolar voltage was assessed.
Main Results:
- Areas with TAD covered a small epicardial surface (7.7%) but contained a high percentage of CIS (95%) and VRS (82%).
- Late gadolinium enhancement and low unipolar voltage areas also showed significant overlap with CIS and VRS, but TAD was more specific.
- TAI analysis provides a voltage-independent method for substrate identification.
Conclusions:
- Transmural activation interval is a novel tool for identifying intramural VT substrates in DCM.
- This method can improve the precision of VT ablation by better localizing critical ablation sites.
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