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Functional Substrate Mapping in Ablation for Scar-Related Ventricular Tachycardia.

Shiro Nakahara1, Hirotsugu Sato1, Jason S Bradfield2

  • 1Department of Cardiology, Dokkyo Medical University Saitama Medical Center, 343-8555 Koshigaya, Japan.

Reviews in Cardiovascular Medicine
|March 6, 2026
PubMed
Summary

New substrate mapping techniques improve ventricular tachycardia (VT) ablation by identifying scar-related abnormalities without inducing VT. These advances enhance safety and accuracy for patients with structural heart disease.

Keywords:
catheter ablationfunctional substrate mappingmagnetic resonance imagingmulti-electrode mappingventricular arrhythmiaventricular tachycardia

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Imaging

Background:

  • Ventricular tachycardia (VT) in structural heart disease is often hemodynamically unstable.
  • Inducing VT for mapping can be risky.
  • Identifying the electrical substrate is crucial for successful ablation.

Purpose of the Study:

  • To review advanced substrate mapping techniques for scar-related VT.
  • To highlight technological improvements in electrophysiology mapping.
  • To discuss non-invasive imaging for VT ablation planning.

Main Methods:

  • High-density multi-electrode catheter mapping.
  • Isochronal late activation mapping and pacing site modification.
  • Near-field algorithms and analysis of conduction block.
  • Cardiac MRI and CT with specialized software.

Main Results:

  • New techniques enable substrate identification without inducing VT.
  • Improved accuracy in detecting local abnormal ventricular activity (LAVA).
  • Non-invasive imaging aids in estimating VT isthmus location.

Conclusions:

  • Advanced substrate mapping enhances VT ablation safety and reduces complexity.
  • Technological integration improves the identification of VT substrates.
  • Expanded patient eligibility for VT ablation is anticipated.