Quantifying the determinants of decremental response in critical ventricular tachycardia substrate

Beheshti, Mohammadali; Nayyar, Sachin; Magtibay, Karl; Massé, Stéphane; Porta‐Sánchez, Andreu; Haldar, Shouvik; Bhaskaran, Abhishek; Vigmond, Edward J.; Nanthakumar, Kumaraswamy

doi:10.1016/j.compbiomed.2018.05.025

Cited by 9 publications

(6 citation statements)

References 12 publications

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“…First of all, repeated pacing in patients with a depressed ventricular function that is aggravated by recurrent VT episodes is not without risk. Furthermore, electrophysiologically speaking, the magnitude of delay is subject to several variables, including the pacing location, the characteristics of the conducting channel as well as the coupling interval of the extrastimulus [ 29 , 30 ]. Stimulation in the vicinity of the scar tissue from the side opposite to the entrance site produces longer delays.…”

Section: Discussionmentioning

confidence: 99%

Ablation targets of scar-related ventricular tachycardia identified by dynamic functional substrate mapping

Elewa,

Altoukhy,

Badran

et al. 2023

Egypt Heart J

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Background Dynamic functional substrate mapping of scar-related ventricular tachycardia offers better identification of ablation targets with limited ablation lesions. Several functional substrate mapping approaches have been proposed, including decrement-evoked potential (DEEP) mapping. The aim of our study was to compare the short- and long-term efficacy of a DEEP-guided versus a fixed-substrate-guided strategy for the ablation of scar-related ventricular tachycardia (VT). Results Forty consecutive patients presenting for ablation of scar-related VT were randomized to either DEEP-guided or substrate-guided ablation. Late potentials were tagged and ablated in the non-DEEP group, while those in the DEEP group were subjected to RV extrastimulation after a drive train. Only potentials showing significant delay were ablated. Patients were followed for a median duration of 12 months. Twenty patients were allocated to the DEEP group, while the other 20 were allocated to the non-DEEP group. Twelve patients (60%) in the DEEP group had ischemic cardiomyopathy versus 10 patients (50%) in the non-DEEP group (P-value 0.525). Intraoperatively, the median percentage of points with LPs was 19% in the DEEP group and 20.6% in the non-DEEP group. The procedural time was longer in the DEEP group, approaching but missing statistical significance (P-value 0.059). VT non-inducibility was successfully accomplished in 16 patients (80%) in the DEEP group versus 17 patients (85%) in the non-DEEP group (P value 0.597). After a median follow-up duration of 12 months, the VT recurrence rate was 65% in both groups (P value 0.311), with a dropout rate of 10% in the DEEP group. As for the secondary endpoints, all-cause mortality rates were 20% and 25% in the DEEP and non-DEEP groups, respectively (P-value 0.342). Conclusions DEEP-assisted ablation of scar-related ventricular tachycardia is a feasible strategy with comparable short- and long-term outcomes to a fixed-substrate-based strategy with more specific ablation targets, albeit relatively longer but non-significant procedural times and higher procedural deaths. The imbalance between the study groups in terms of epicardial versus endocardial mapping, although non-significant, warrants the prudent interpretation of our results. Further large-scale randomized trials are recommended. Trial registration: clinicaltrials.gov, registration number: NCT05086510, registered on 28th September 2021, record https://classic.clinicaltrials.gov/ct2/show/NCT05086510

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Section: Discussionmentioning

confidence: 99%

Ablation targets of scar-related ventricular tachycardia identified by dynamic functional substrate mapping

Elewa,

Altoukhy,

Badran

et al. 2023

Egypt Heart J

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“…We have developed decrement evoked potential (EP) (DeEP) mapping as a novel method shown to be an effective, focused, and minimalistic strategy to identify arrhythmogenic sites without the need to induce VT. This approach was initially developed from human intraoperative data, 2 which were tested in a computer-modeled simulation 4 and then prospectively validated in a randomized multicenter trial. 3 This methodology has been included in recent Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society/Latin-American Heart Rhythm Society VT guidelines for substrate-guided VT ablation.…”

Section: Introductionmentioning

confidence: 99%

Automated Identification of Ventricular Tachycardia Ablation Targets: Multicenter Validation and Workflow Characterization

Niri¹,

Shapira²,

Massé³

et al. 2022

J Innov Cardiac Rhythm Manage.

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“…Previous studies focused DeEP mapping to pre-defined areas of interest rather than mapping the entire ventricle. 2 , 3 , 5 , 6 This may overestimate the specificity, which improves when DeEP mapping is guided by additional substrate information. This mechanistic study was non-randomized and patients with one clinical VT were included.…”

mentioning

confidence: 99%

Optimization of decrementing evoked potential mapping for functional substrate identification in ischaemic ventricular tachycardia ablation

et al. 2023

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Quantifying the determinants of decremental response in critical ventricular tachycardia substrate

Cited by 9 publications

References 12 publications

Ablation targets of scar-related ventricular tachycardia identified by dynamic functional substrate mapping

Ablation targets of scar-related ventricular tachycardia identified by dynamic functional substrate mapping

Automated Identification of Ventricular Tachycardia Ablation Targets: Multicenter Validation and Workflow Characterization

Optimization of decrementing evoked potential mapping for functional substrate identification in ischaemic ventricular tachycardia ablation

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