Substrate‐Based Ablation Versus Ablation Guided by Activation and Entrainment Mapping for Ventricular Tachycardia: A Systematic Review and Meta‐Analysis

Abstract

This meta-analysis demonstrates similar acute procedural efficacy, and complications, VT recurrence and mortality rates when comparing a predominantly substrate-based ablation strategy to a strategy guided predominantly by activation and entrainment mapping of inducible and hemodynamically tolerated VTs.

Outcomes of catheter ablation of ventricular tachycardia with mechanical hemodynamic support: An analysis of the Medicare database

“…Instead, the success of VT ablation is likely contingent upon a multitude of variables some of which are practically independent of the ability to perform enhanced mapping . Second, catheter ablation of postmyocardial infarction VT using substrate‐based modification generally carries a favorable success rate . Furthermore, the latter may also be associated with reduced heart failure than the conventional entrainment/mapping approach.…”

Late potentials abolition reduces ventricular tachycardia recurrence after ablation especially in higher‐risk patients with a chronic total occlusion in an infarct‐related artery

“…Several approaches for substrate modification have been proposed; among them, late potentials (LPs) abolition is well recognized as an effective strategy that provides incremental prognostic benefit on top of VT noninducibility . However, a recent meta‐analysis suggests that there are no significant differences in terms of acute and long‐term outcomes between substrate ablation and ablation strategies guided by activation and entrainment mapping during VT …”

Effectiveness of a percutaneous left ventricular assist device in preventing acute hemodynamic decompensation during catheter ablation of ventricular tachycardia in advanced heart failure patients: A retrospective single‐center analysis

“…However, it is important to consider the VT burden in procedures based on substrate ablation as well. Spontaneous occurrence of VT during substrate mapping/ablation has been reported in between 20% and 38% . In our study, 50% of the patients experienced spontaneous, monomorphic, unstable, and sustained VT during substrate mapping/ablation as the “first step” of the ablation procedure.…”

“…Substrate mapping and ablation in VT ablation procedures might be one way to identify critical arrhythmogenic tissue without activation mapping and VT induction in patients with advanced heart failure . Comparisons between both ablation strategies are mainly reported in patients with hemodynamically stable VT . However, it is important to consider the VT burden in procedures based on substrate ablation as well.…”