Dynamic high-density functional substrate mapping to treat ventricular tachycardia—Time for electrophysiology to come home

  • Pier D. Lambiase
    Address reprint requests and correspondence: Dr Pier D. Lambiase, Institute of Cardiovascular Science, Barts Heart Centre, University College London, West Smithfield, London EC1A 7BE, United Kingdom.
    Institute of Cardiovascular Science, Barts Heart Centre, University College London, London, United Kingdom
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Published:January 18, 2021DOI:
      Ventricular tachycardia (VT) ablation remains a significant challenge because of the fragility of many of the patients requiring the procedure and the plethora of proposed strategies to target the substrate. What is required are simple, highly reproducible mechanistically based approaches that define the circuit with minimal subjectivity to enable translation into routine ablation practice akin to accessory pathway ablation.
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        • Arenal A.
        • Glez-Torrecilla E.
        • Ortiz M.
        • et al.
        Ablation of electrograms with an isolated, delayed component as treatment of unmappable monomorphic ventricular tachycardias in patients with structural heart disease.
        J Am Coll Cardiol. 2003; 41: 81-92
        • Sacher F.
        • Lim H.S.
        • Derval N.
        • et al.
        Substrate mapping and ablation for ventricular tachycardia: the LAVA approach.
        J Cardiovasc Electrophysiol. 2015; 26: 464-471
        • Harada T.
        • Stevenson W.G.
        • Kocovic D.Z.
        • Friedman P.L.
        Catheter ablation of ventricular tachycardia after myocardial infarction: relation of endocardial sinus rhythm late potentials to the reentry circuit.
        J Am Coll Cardiol. 1997; 30: 1015-1023
        • Anter E.
        • Kleber A.G.
        • Rottmann M.
        • et al.
        Infarct-related ventricular tachycardia: redefining the electrophysiological substrate of the isthmus during sinus rhythm.
        JACC Clin Electrophysiol. 2018; 4: 1033-1048
        • Kuck K.H.
        • Schaumann A.
        • Eckardt L.
        • et al.
        Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial.
        Lancet. 2010; 375: 31-40
        • Aziz Z.
        • Shatz D.
        • Raiman M.
        • et al.
        Targeted ablation of ventricular tachycardia guided by wavefront discontinuities during sinus rhythm: a new functional substrate mapping strategy.
        Circulation. 2019; 140: 1383-1397
        • Porta-Sánchez A.
        • Jackson N.
        • Lukac P.
        • et al.
        Multicenter study of ischemic ventricular tachycardia ablation with decrement-evoked potential (DEEP) mapping with extra stimulus.
        JACC Clin Electrophysiol. 2018; 4: 307-315
        • Srinivasan N.T.
        • Garcia J.
        • Schilling R.J.
        • et al.
        Multicenter study of dynamic high-density functional substrate mapping improves identification of substrate targets for ischemic ventricular tachycardia ablation.
        JACC Clin Electrophysiol. 2020; 6: 1783-1793
        • Crinion D.
        • Neira V.
        • Al Hamad N.
        • et al.
        Close-coupled pacing to identify the “functional” substrate of ventricular tachycardia: long-term outcomes of the paced electrogram feature analysis technique.
        Heart Rhythm. 2021; 18: 723-731
        • Brunckhorst C.B.
        • Stevenson W.G.
        • Jackman W.M.
        • et al.
        Ventricular mapping during atrial and ventricular pacing: relationship of multipotential electrograms to ventricular tachycardia reentry circuits after myocardial infarction.
        Eur Heart J. 2002; 23: 1131
        • Child N.
        • Bishop M.J.
        • Hanson B.
        • et al.
        An activation-repolarization time metric to predict localized regions of high susceptibility to re-entry.
        Heart Rhythm. 2015; 12: 1644-1653
        • Orini M.
        • Graham A.J.
        • Srinivasan N.T.
        • et al.
        Evaluation of the reentry vulnerability index to predict ventricular tachycardia circuits using high-density contact mapping.
        Heart Rhythm. 2020; 17: 576-583

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