Mapping of ventricular tachycardia in patients with ischemic cardiomyopathy: Current approaches and future perspectives

Abstract

Despite the technical improvements made in recent years, the overall long‐term success rate of ventricular tachycardia (VT) ablation in patients with ischemic cardiomyopathy remains disappointing. This unsatisfactory situation has persisted even though several approaches to VT substrate ablation allow mapping and ablation of noninducible/nontolerated arrhythmias. The current substrate mapping methods present some shortcomings regarding the accurate definition of the true scar, the modality of detection in sinus rhythm of abnormal electrograms that identify sites of critical channels during VT and the possibility to determine the boundaries of functional re‐entrant circuits during sinus or paced rhythms. In this review, we focus on current and proposed ablation strategies for VT to provide an overview of the potential/real application (and results) of several ablation approaches and future perspectives.

Electroanatomic voltage mapping for tissue characterization beyond arrhythmia definition: A systematic review

“…These findings regarding LV voltage mapping were soon followed by other observations about the diagnostic power of unipolar endocardial mapping, particularly when used to identify far field locations of epicardial bipolar low‐voltage regions in patients with dilated cardiomyopathy 44 …”

Cardiac stereotactic ablative radiotherapy for refractory ventricular arrhythmias: A radical alternative? A narrative review of rationale and cardiological aspects

“…This technique, called "VT activation mapping", is a reference technique for treating a hemodynamically well tolerated VT (Figure 2, Panel B). However, this mapping technique is not feasible when the patient presents nonsustained VTs or VTs with poor haemodynamic tolerance (34).…”

The scar: the wind in the perfect storm—insights into the mysterious living tissue originating ventricular arrhythmias

“…Hence, reperfusion therapy increases scar heterogeneity, number of VT channels and therefore scar arrhythmogenicity, influencing ablative approaches [ 9 ]. Due to the shorter VT cycle length, nowadays ischemic scar-related VTs are fast, unstable, haemodinamically not tolerated and unmappable by classic entrainment techniques in almost 90% of cases, requiring a substrate-based approach relying on voltage mapping and elimination of all abnormal and late potentials within the infarct zone [ 10 ].…”