Background
Established electroanatomic mapping techniques for substrate mapping for ventricular
tachycardia (VT) ablation includes voltage mapping, isochronal late activation mapping
(ILAM), and fractionation mapping. Omnipolar mapping (Abbott Medical, Inc.) is a novel
optimized bipolar electrogram creation technique with integrated local conduction
velocity annotation. The relative utilities of these mapping techniques are unknown.
Objective
The purpose of this study was to evaluate the relative utility of various substrate
mapping techniques for the identification of critical sites for VT ablation.
Methods
Electroanatomic substrate maps were created and retrospectively analyzed in 27 patients
in whom 33 VT critical sites were identified.
Results
Both abnormal bipolar voltage and omnipolar voltage encompassed all critical sites
and were observed over a median of 66 cm2 (interquartile range [IQR] 41.3–86 cm2) and 52 cm2 (IQR 37.7–65.5 cm2), respectively. ILAM deceleration zones were observed over a median of 9 cm2 (IQR 5.0–11.1 cm2) and encompassed 22 critical sites (67%), while abnormal omnipolar conduction velocity
(CV <1 mm/ms) was observed over 10 cm2 (IQR 5.3–16.6 cm2) and identified 22 critical sites (67%), and fractionation mapping was observed over
a median of 4 cm2 (IQR 1.5–7.6 cm2) and encompassed 20 critical sites (61%). The mapping yield was the highest for fractionation
+ CV (2.1 critical sites/cm2) and least for bipolar voltage mapping (0.5 critical sites/cm2). CV identified 100% of critical sites in areas with a local point density of >50
points/cm2.
Conclusion
ILAM, fractionation, and CV mapping each identified distinct critical sites and provided
a smaller area of interest than did voltage mapping alone. The sensitivity of novel
mapping modalities improved with greater local point density.
Keywords
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Article info
Publication history
Published online: February 28, 2023
Publication stage
In Press Journal Pre-ProofFootnotes
Funding Sources: The authors have no funding sources to disclose.
Disclosures: Relationships to industry are all modest (<$10,000). Dr Barbhaiya has received consulting fees/honoraria from Abbott, Biosense Webster, and Zoll. Dr Aizer has received fellowship support from Abbott, Biotronik, Boston Scientific, and Medtronic. Dr Chinitz has received speaking fees/honoraria from Abbott, Medtronic, Biotronik, and Biosense and fellowship/research support from Medtronic, Biotronik, and Biosense. The rest of the authors report no conflicts of interest.
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