Combination of High-Density and Coherent Mapping for Ablation of Ventricular Arrhythmia in Patients with Structural Heart Disease

Abstract

The present study describes our experience with a new mapping approach for ventricular arrhythmia (VA) ablation in patients with structural heart disease (SHD). Consecutive patients undergoing catheter ablation for recurrent VA were analyzed. High-density mapping was conducted in all patients. In patients with inducible VA, local activation time (LAT) mapping and a novel vector-based mapping algorithm were implemented to analyze arrhythmia propagation. In case of focal tachycardia, the location of earliest activation was targeted. In VAs with re-entrant mechanisms, zones of slow conduction based on coherent mapping were ablated. Substrate modification was performed when pathologic electrograms were identified. Seventy-four patients were included. Sixty-five patients (87.8%) were male. Ischemic cardiomyopathy was the underlying disease in 35 patients (47.3%) and nonischemic cardiomyopathy was the underlying disease in 39 patients (52.7%). Mean left ventricular ejection fraction was 33.8 ± 9.9%. Non-inducibility of any VA was achieved in 70 patients (94.6%). Termination of VA was achieved in 93.5% of patients with stable VA. In 4 patients (5.4%), partial success was achieved. VA (p < 0.001), ATP (p < 0.001) and shock burden (p = 0.001) were significantly reduced after ablation. Mean arrhythmia-free survival after 12 months was 85.1 ± 4.7%. High-density mapping in combination with coherent mapping may facilitate the understanding of the tachycardia mechanism, providing targets for effective ablation.

Multipolar mapping in the management of different arrhythmias

“…Данные катетеры широко применяются в лечении как ЖА при структурных заболеваниях сердца, так без структурной патологии сердца. Повышение эффективности интервенционных процедур стало возможным благодаря целому ряду преимуществ: аблация ЖА после построе ния вольтажной карты высокого разрешения и с применением современного программного обеспечения сокращает время процедуры и снижает число осложнений [17,18], аблация ЖА с использованием многоконтактных электродов снижает частоту срабатываний имплантируемых кардиовертер-дефибрилляторов, частоту госпитализаций по поводу ЖА и частоту развития электрического шторма [19].…”