The value of functional substrate mapping in ventricular tachycardia ablation

Vlachos, Konstantinos; Letsas, Κonstantinos P.; Srinivasan, Neil; Frontera, Antonio; Efremidis, Michael; Dragasis, Stylianos; Martin, Claire; Martin, Ruaridh; Nakashima, Takashi; Bazoukis, George; Kitamura, Τakeshi; Mililis, Panagiotis; Saplaouras, Athanasios; Georgopoulos, Stamatios; Sofoulis, Stamatios; Kariki, Ourania; Koskina, Stavroula; Takigawa, Masateru; Sacher, Frédéric; Jaı̈s, Pierre

doi:10.1016/j.hroo.2022.10.013

Cited by 9 publications

(3 citation statements)

References 70 publications

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“…Our primary finding, which demonstrates reduced rates of VT recurrence in a severe subset of patients, substantiates earlier hypotheses suggesting improved outcomes for patients undergoing functional map-based ablation 34 . It is essential to note that our study cohort comprises patients with highly severe cardiomyopathy, with 86.2% of them experiencing electrical storms prior to ablation.…”

Section: Discussionsupporting

confidence: 88%

“…Given the extensive epicardial and endocardial substrate involved in Chagas VT ablation, it is anticipated that this procedure may carry higher rates of VT recurrence, as indicated in some prior reports 33 . Our primary finding, which demonstrates reduced rates of VT recurrence in a severe subset of patients, substantiates earlier hypotheses suggesting improved outcomes for patients undergoing functional map-based ablation 34 . It is essential to note that our study cohort comprises patients with highly severe cardiomyopathy, with 86.2% of them experiencing electrical storms prior to ablation.…”

Section: Discussionsupporting

confidence: 88%

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Enhancing Ventricular Tachycardia Ablation Outcomes: The Impact of Functional Mapping in Chagas Cardiomyopathy

Wilnes,

Castello-Branco,

de Araújo Silva

et al. 2024

Preprint

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Background: Chagas cardiomyopathy presents a significant public health challenge in Latin America, marked by high rates of ventricular tachycardia (VT) and implantable cardioverter-defibrillator (ICD) interventions. This study explores the efficacy of functional mapping strategies in VT ablation for Chagas cardiomyopathy compared to conventional voltage map-based approaches. Methods: This observational study, involving 66 patients, employed electroanatomic mapping for both epicardial and endocardial regions. In voltage-based mapping (group 1), all patients underwent bipolar substrate mapping with standard scar settings for epicardial and endocardial regions, while functional mapping (group 2) was obtained using a single ventricular extra-stimulus with Late Potential and Isochronal Late Activation Maps associated with annotation of decremental and blocked electrograms. The primary endpoint was post-ablation VT recurrence over a 30-month follow-up. Results: Voltage-based and functional mapping groups presented 42 and 24 patients, respectively. When compared to the voltage-based mapping strategy, functional mapping-assisted procedures were associated with lower post-ablation VT recurrence on Kaplan-Meier's log-rank test (P=0.045). After multivariate analysis, functional mapping independently associated with a 90.3% reduction in the risk of 30-month VT recurrence (HR: 0.097, 95% CI: 0.012-0.760, P=0.026) compared to voltage-based mapping. Conclusion: Functional mapping in Chagas cardiomyopathy VT ablation is associated with significantly reduced recurrence rates, emphasizing its potential as an effective strategy in this challenging condition. This study provides valuable insights for improving VT ablation outcomes. However, there is a dire need for a large-scale randomized controlled trial to generate high-quality evidence in this field.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 88%

Enhancing Ventricular Tachycardia Ablation Outcomes: The Impact of Functional Mapping in Chagas Cardiomyopathy

Wilnes,

Castello-Branco,

de Araújo Silva

et al. 2024

Preprint

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show abstract

“…Such presumed areas of scar frequently have their border zones close to relatively healthy myocardial tissue. Collision of multiple wavefronts arising from scar and nearby myocardium can have an influence on the ultimate signal formation [15], and this can impair the accuracy of mapping performed during sinus rhythm or regular ventricular pacing. Previous studies have shown that ventricular electrograms, which demonstrated decremental conduction using decrement evoked potentials (DEEP) during right ventricular apical pacing with an extra-stimulus, are more likely to participate in reentrant VT circuits than conventional substrate ablation targets [16].…”

Section: Mappingmentioning

confidence: 99%

Challenges in Ventricular Arrhythmia Ablation: Difficult Substrates and Advanced Ablation Strategies

Zarębski,

Futyma

2024

Curr Treat Options Cardio Med

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Purpose of review During challenging scenarios of ventricular arrhythmia (VA) ablation, novel strategies to target the arrhythmogenic substrate are sometimes essential for clinical success. While catheter ablation (CA) can offer relatively high efficacy, it may not always lead to complete VA eradication in certain individuals. This article provides a brief overview of difficult substrate ablation strategies in patients with premature ventricular contractions (PVC) or ventricular tachycardia (VT) and explores methods to improve outcomes for cases that do not respond to typical ablation techniques. Recent findings Recent developments highlight the crucial role of advanced imaging and mapping techniques in the visualization, characterization, and localization of challenging ventricular substrates. Additionally, some novel and advanced ablation strategies may be useful when PVC/VT is refractory to conventional ablation treatment. Summary An expanding spectrum of techniques which can optimize the precision and effectiveness of catheter ablation procedures may improve PVC/VT ablation outcomes. Novel ablation therapies such as alcohol ablation, optimization of dispersive patch positions, or bipolar ablation, can overcome obstacles associated with the challenging anatomy of arrhythmia.

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Technological advances in ventricular tachycardia catheter ablation: the relentless quest for novel solutions to old problems

Compagnucci,

Valeri,

Conti

et al. 2023

J Interv Card Electrophysiol

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The value of functional substrate mapping in ventricular tachycardia ablation

Cited by 9 publications

References 70 publications

Enhancing Ventricular Tachycardia Ablation Outcomes: The Impact of Functional Mapping in Chagas Cardiomyopathy

Enhancing Ventricular Tachycardia Ablation Outcomes: The Impact of Functional Mapping in Chagas Cardiomyopathy

Challenges in Ventricular Arrhythmia Ablation: Difficult Substrates and Advanced Ablation Strategies

Technological advances in ventricular tachycardia catheter ablation: the relentless quest for novel solutions to old problems

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