Functional Substrate Mapping in Ablation for Scar-Related Ventricular Tachycardia

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.