Catheter Ablation -> Ventricular Arrhythmias -> Clinical Trials / Outcomes D-PO05 - Poster Session V (ID 39) Poster

D-PO05-199 - Improved Ablation Outcomes From Dynamic Functional Substrate Mapping Of Ventricular Tachycardia (ID 590)


Background: The presence of dynamic substrate changes facilitate functional block and reentry in ventricular tachycardia (VT) but are rarely studied as part of clinical VT mapping.
Objective: We aimed to study the role of dynamic substrate changes in facilitating conduction delay and reentry in VT circuits.
Methods: Thirty patients (age 67 +/- 9yrs, 27Male) underwent ablation. Mapping was performed with the AdvisorTM HD Grid multipolar catheter. A bipolar voltage map was obtained during sinus rhythm (SR) and RV Sensed Protocol (SP) single extra pacing. SR and SP late potential (LP) and local abnormal ventricular activity (LAVA) maps were made and compared with critical sites for ablation, defined as sites of best entrainment or pace mapping. Ablation was then performed to critical sites and LP/LAVA identified by the SP.
Results: At a median follow up of 10 months 90% of patients were free from symptomatic ATP or ICD shocks. SP pacing resulted in a larger area of LP identified for ablation 19.3mm2 vs 6.4mm2 during SR mapping(p=0.001). SP late potentials were located at critical ablation sites in 24 patients compared to 7 in SR mapping (p<0.001).
Conclusion: LP and LAVA seen during the SP were able to identify regions critical for ablation in VT with a greater accuracy than sinus rhythm mapping. The combination of ablation to critical sites and SP derived LP/LAVA resulted in significantly improved outcomes of VT ablation compared to the published literature.