Complete Electroanatomic Imaging of the Diastolic Pathway Is Associated With Improved Freedom From Ventricular Tachycardia Recurrence

Abstract

Background - The development of multielectrode mapping catheters has expanded the spectrum of mappable ventricular tachycardias (VTs). Full diastolic pathway recording has been associated with a high rate of VT termination during radiofrequency (RF) ablation as well as non inducibility at study end. However, the role of diastolic pathway mapping on VT recurrence has yet to be clearly elucidated. We aimed to explore the role of complete diastolic pathway activation mapping on VT recurrence. Methods - 85 consecutive patients who underwent VT ablation guided by high-density mapping were enrolled. During activation mapping, the presence of electrical activity in all segments of diastole defined the evidence of having had recorded the whole diastolic interval. Patients were categorized as having recorded the full diastolic pathway, partial diastolic pathway, or no diastolic pathway map performed. Recurrences of VT were defined as appropriate ICD therapies or on the basis of ECG-documented arrhythmia. Results - 85 patients were included. Complete recording of the diastolic pathway was achieved in 36/85 (42.4%) patients. Partial recording of the diastolic pathway of the clinical VT was achieved in 24/85 (28.2%) patients. No recording of the diastolic pathway of the clinical VT was feasible in 25/85 patients (29.4%). At a mean of 12.8 months, freedom from VT recurrence was 67% in the overall cohort. At a mean of 12.8 months, freedom from VT recurrence was 88%, 50%, and 55% in patients who had full diastolic activity recorded, partial diastolic activity recorded, or underwent substrate modification, respectively; the observed differences were statistically significant (p=0.02). Conclusions - Mapping of the entire diastolic pathway was associated with a higher freedom from VT recurrence as compared to partial diastolic pathway recording and substrate modification. The use of multielectrode mapping catheters in recording diastolic activity may help predict those VTs employing intramural circuits and further optimize ablation strategies.

Influence of baseline inducibility and activation mapping on ablation outcomes in patients with structural heart disease and ventricular tachycardia

“…The utility of VT activation mapping has been recently described. 19,20 Hadjis et al 19 showed that VT recurrence was significantly lower among those patients with complete delineation of the diastolic pathway (12%) during VT when compared with partial or no recording of the diastolic pathway (50% and 45%, respectively, p = .02).…”

Structure and function of the ventricular tachycardia isthmus

“…The benefit of catheter ablation in reentrant VT patients with structural heart disease is wellknown, with freedom from recurrence approaching 70% (188). However, the success rate with this procedure has plateaued, despite advances in both mapping catheter technology and electroanatomic mapping systems (188,189).…”

“…The benefit of catheter ablation in reentrant VT patients with structural heart disease is wellknown, with freedom from recurrence approaching 70% (188). However, the success rate with this procedure has plateaued, despite advances in both mapping catheter technology and electroanatomic mapping systems (188,189). High density multi-electrode catheters can enhance the possibility of detailed activation mapping of even poorly tolerated VTs because they can be produced in a reasonable time frame.…”

Data integration for the numerical simulation of cardiac electrophysiology

“…Electrophysiological studies, through the acquisition of endocavitary signals, aim at recognizing those arrhythmogenic regions, which can form localized or macro‐reentry circuits. Activation maps and EGMs morphology reveal the presence of areas of slowing (fibrotic tissue) and conduction blocking (scar tissue) 45,46 . The mathematical analysis of these data, in the form of biomarkers calculation, provides a first quantitative tool in support of the electrophysiologist 9 .…”