Substrate characterization and catheter ablation in patients with scar‐related ventricular tachycardia using ultra high‐density 3‐D mapping

Abstract

Ultra high-density mapping in patients with scar-related VT is feasible, safe and enables detailed insight into tachycardia mechanisms. Critical sites can be identified (1) by precise substrate characterization when VT is not inducible or hemodynamically not tolerated and (2) during short lasting episodes of VT in order to guide catheter ablation.

Local impedance guides catheter ablation in patients with ventricular tachycardia

“…A 6‐French quadripolar diagnostic catheter (Inquiry, 5 mm spacing; St. Jude Medical) was positioned in the right ventricular apex. High‐density‐3D mapping was performed in all patients (Rhythmia, Boston Scientific, Marlborough, MA) as previously described using a 64‐electrode basket‐catheter (Orion, Boston Scientific) during sinus rhythm, ventricular pacing and/or VT as appropriate. The left ventricle was accessed via a femoral retrograde transaortic approach (9 French, Terumo, Leuven, Belgium) or by transseptal access using a fixed curve long sheath (SL0, 8 French, St. Jude Medical).…”

“…The left ventricle was accessed via a femoral retrograde transaortic approach (9 French, Terumo, Leuven, Belgium) or by transseptal access using a fixed curve long sheath (SL0, 8 French, St. Jude Medical). A steerable long sheath (Agilis large curl, 8.5 French, St. Jude Medical) was used for transseptal mapping and ablation . To maintain deep sedation, patients received propofol (2 mg/mL, B. Braun, Melsungen, Germany) combined with boluses of fentanyl (0.1 mg/mL, Rotexmedica, Trittau, Germany).…”

Ten‐year trends in catheter ablation for ventricular tachycardia vs other interventional procedures in Australia

“…Implementation of electroanatomical mapping systems to characterize LV scar geometry and “real‐time” catheter location is now used almost exclusively in VT ablative procedures has been a significant advance in this field. Mapping is now greatly assisted by the development of multielectrode catheters with smaller electrodes and spacing capable of rapid, ultrahigh density maps with elegant automatic annotation algorithms and improved spatial resolution . Integration of imaging modalities (eg, cardiac magnetic resonance imaging) is also being increasing used to guide ablation with improved outcomes .…”

“…19 AIHW, Australian Institute of Health, Welfare and Aging heart failure have been shown to reduce mortality, 23 resolution. 30 Integration of imaging modalities (eg, cardiac magnetic resonance imaging) is also being increasing used to guide ablation with improved outcomes. 31 A major paradigm shift in the current era has been a transition from a conventional "standard" procedure where VT must be induced to a "substrate-based" approach, avoiding unnecessary procedural risk caused by hemodynamic compromise from inducing VT. A substrate-based approach uses techniques to locate key components of the VT circuit in sinus rhythm (without the need to induce VT).…”

Do new tools help us identify substrate to target for ablation in ventricular tachycardia?

“…Multiple studies have identified distinct characteristics within ventricular scar and thereby proposed different targets and approaches for substrate‐based ablation. In the present study, Nührich et al . describe the application of a new “ultra‐high resolution” mapping system (Rhythmia HDx TM by Boston Scientific, Marlborough, MA, USA) to the characterization of scar for catheter ablation in the context of this evolution of the definition of the electroanatomic substrate for VT.…”