New Substrate-Guided Method of Predicting Slow Conducting Isthmuses of Ventricular Tachycardia

Abstract

BACKGROUND:Several conducting channels of ventricular tachycardia (VT) can be identified using voltage limit adjustment (VLA) of substrate mapping. However, the sensitivity or specificity to predict a VT isthmus is not high by using VLA alone. This study aimed to evaluate the efficacy of the combined use of VLA and fast-Fourier transform analysis to predict VT isthmuses. METHODS AND RESULTS:VLA and fast-Fourier transform analyses of local ventricular bipolar electrograms during sinus rhythm were performed in 9 postinfarction patients who underwent catheter ablation for a total of 13 monomorphic VTs. Relatively higher voltage areas on an electroanatomical map were defined as high voltage channels (HVCs), and relatively higher fast-Fourier transform areas were defined as highfrequency channels (HFCs). HVCs were classified into full or partial HVCs (the entire or >30% of HVC can be detectable, respectively). Twelve full HVCs were identified in 7 of 9 patients. HFCs were located on 7 of 12 full HVCs. Five VT isthmuses (71%) were included in the 7 full HVC+/ HFC+ sites, whereas no VT isthmus was found in the 5 full HVC+/HFC− sites. HFCs were identical to 9 of 16 partial HVCs. Eight VT isthmuses (89%) were included in the 9 partial HVC+/HFC+ sites, whereas no VT isthmus was found in the 7 partial HVC+/HFC− sites. All HVC+/HFC+ sites predicted VT isthmus with a sensitivity of 100% and a specificity of 80%. CONCLUSIONS:Combined use of VLA and fast-Fourier transform analysis may be a useful method to detect VT isthmuses.

JCS/JHRS 2019 guideline on non‐pharmacotherapy of cardiac arrhythmias

“…A new method of analyzing frequency has been reported as a technique for discriminating characteristics other than visual potential characteristics, such as intracardiac voltage and late potentials in abnormal areas. 1072 , 1073 …”

Mapping the unmappable—Rapid high-density contact mapping in hemodynamically unstable ventricular tachycardia using a novel star-shaped multipolar catheter

“…Traditional methods include voltage- and EGM-based approaches like late potential and local abnormal ventricular activity mapping. 9 More recently, functional substrate mapping approaches aiming to identify zones of deceleration 10 and decremental conduction by means of various protocols 11 or rotational activity at baseline rhythm, 12 frequency-based mapping techniques, 13 and purely imaging-guided ablation 14 have gained popularity in an effort to minimize the need for VT induction associated with a risk of hemodynamic compromise and requirement for cardioversion.…”

Efficacy of Spectral Signatures for the Automatic Classification of Abnormal Ventricular Potentials in Substrate-Guided Mapping Procedures

“…Specifically, during substrate-guided mapping, bipolar electrograms (EGMs) recorded from damaged myocardial areas are carefully inspected by electrophysiologists, in order to identify those late and fractionated pathological deflections associated with arrhythmogenic areas. These pathological potentials, generally named abnormal ventricular potentials (AVPs), have been often associated with high-frequency components in the scientific literature [3]- [7], and more recently, their spectral contents have been deeply investigated [8], highlighting the presence of peculiar spectral signatures for AVPs. However, there is no evidence that such spectral signatures may be effective for the automatic recognition of AVPs and physiological EGMs, despite the usefulness of artificial intelligence tools for the recognition of arrhythmogenic zones in patients suffering from postischaemic VT has been already investigated [9], [10].…”