Dominant Frequency Mapping as a Functional Tool for Substrate-Guided Ventricular Tachycardia Ablation

Area of Science:

• Cardiology
• Medical Imaging
• Computational Electrophysiology

Background:

• Accurate identification of arrhythmogenic substrate is crucial for successful ventricular tachycardia (VT) ablation.
• Existing electrogram-based methods for VT ablation are limited by far-field interference and operator dependence.
• Dominant frequency (DF) mapping is a stimulus-independent alternative but lacks integrated anatomical workflows and quantitative spatial assessment.

Purpose of the Study:

• To develop and evaluate a computational workflow for DF mapping with 3D anatomical integration.
• To assess the spatial concordance between DF activity and operator-defined VT ablation sites.

Main Methods:

• Retrospective analysis of 12 patients with VT undergoing substrate-guided ablation.
• Intracardiac electrograms were processed for DF analysis and projected onto patient-specific ventricular meshes.
• Spatial correspondence was quantified using proximity metrics and receiver operating characteristic (ROC) analysis.

Main Results:

• DF analysis was successful in all cases with projection errors < 4 mm.
• DF activity demonstrated high spatial concordance with ablation sites (high soft recall, variable soft precision).
• ROC analysis showed significant improvement over baseline, with SmartTouch data yielding better discrimination.

Conclusions:

• DF mapping with anatomical integration is feasible and shows consistent spatial concordance with VT ablation targets.
• This stimulus-independent workflow provides a framework for quantitative assessment of spatial relationships with procedural targets.
• Further prospective evaluation in larger cohorts is warranted.