Ventricular Electrograms Duration Map to Detect Ventricular Arrhythmia Substrate: the VEDUM Project Study

Abstract

Background: The analysis of the wave-front activation patterns is crucial for the comprehension and treatment of ventricular tachycardia (VT). The ventricular electrograms duration map (VEDUM) is a potential method to identify areas (VEDUM area) with slow and inhomogeneous activation. There is no available data on the characteristics and the arrhythmogenic role of VEDUM areas identified during sinus/paced rhythm. Methods: Patients referred for VT ablation were enrolled at 3 different centers. VEDUM maps during sinus/paced rhythm as well as substrate and functional maps were created; activation mapping was performed for all hemodynamically tolerated VT. Results: Thirty-two patients (mean age:70.1±9.4 years; males 93.8%) were enrolled. The VEDUM approach was achieved in all patients and the mean size of the VEDUM area was 12.1±6.9 cm 2 (interquartile range, 7.8–14.9 cm 2 ). A significative difference was observed between the electrogram duration in the VEDUM area and the normal tissue (163.7 ms [interquartile range, 142.3–199.2 ms]; versus 65.5 ms [interquartile range, 59.5–76.2 ms]; P <0.001). The VEDUM area was visualized in a dense scar (<0.5 mV) in 19 (59.4%) patients. A deceleration zone and late potentials were recorded inside the VEDUM area in 56.3% and 81.3%, respectively. When a complete VT activation mapping was available, the isthmus projected in the VEDUM area in 93.5% of patients; 8 of them had multiple VTs mapped and in the 87.5% all VT isthmuses were included in the VEDUM area. Conclusions: VEDUM maps allow the identification of discrete areas of inhomogeneous and slow conduction. They represent a potential target for VT ablation, including patients with multiple morphologies.

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

“…It is important to highlight that, as illustrated in Figure 1, we have developed our own workflow, which incorporates the principles of various functional mapping techniques [5][6][7][8][9] .…”

“…In addition, successful VT ablation involves a series of critical steps. Recent advancements in the field have introduced innovative strategies that focus on the functional properties of the ventricular substrate, offering promising results [5][6][7][8][9][10][11] . These strategies hold the potential advantage of precisely targeting substrates situated within normal voltage regions.…”

How Imaging Techniques Improve Ventricular Arrhythmia Ablation: A Multimodality-Based Approach

“…For this purpose, further studies are needed, and new evidence from new techniques will be derived. In this context, we expect in the future more powerful and accurate CMR-also in real timeand CT imaging, epicardial space endoscopy, software for their integration with EAMs, implementation of 3D and 4D ICE, and new EAM techniques, both in sinus/paced rhythm or during VT like the novel VEDUM mapping (a color-coded mapping based on abnormal ventricular EGMs duration representing slow conduction areas) [94][95][96][97].…”