Catheter Ablation -> Ventricular Arrhythmias -> Mapping & Imaging D-PO06 - Poster Session VI (ID 26) Poster

D-PO06-107 - Decremental Evoked Potential Mapping Is A Better Predictor Of Ventricular Tachycardia Diastolic Circuit Compared To Late Potential Mapping In Sinus Rhythm And Right Ventricular Pacing In Ischemic Cardiomyopathy (ID 668)


Background: Mapping late potentials in sinus rhythm or RV pacing as a substrate ablation strategy is widely adopted. HRS 2019 consensus document list decremental evoked potential pacing (DeEP) as a potential novel strategy.
Objective: To compare the mapping of late potentials in sinus rhythm, RV pacing and decremental evoked potential pacing (DeEP) to predict the diastolic activation sites during VT.
Methods: In total 25 VTs in 22 IHD patients were studied. Intraoperative endocardial mapping was performed during VT using 112-bipole endocardial balloon. VT was induced using upto four extra-systoles during a drive train of 400-600ms. The local decrement of EGM during the first extra-systole approaching refractoriness was measured from all electrodes
Results: The average number of diastolic activation sites of VT predicted by mapping in sinus, RV pacing and DeEP were 23%, 31% and 64% (p value <0.01) respectively. The mean sensitivity, specificity, PPV and NPV of mapping to predict diastolic activation in VT were 26%, 96%, 79%, 54% (sinus rhythm), 31%, 82%, 67%, 50% (RV pacing), 64%, 79%, 78%, 67% (DeEP) respectively. The area under curve (mean value) of ROC were non-significant for SR (0.59), RV pacing (0.56) and was significant for DeEP mapping (0.72).
Fig 1. Polar map of LV endocardium. Diastolic activation of 4 VTs shown. Late potential mapping with DeEP (green) had more predictive value for VT diastolic sites (shaded area), compared to late potential mapping in sinus rhythm (yellow) or during RV pacing (Orange).
Conclusion: DeEP mapping had better predictive value for VT diastolic sites, compared to mapping late potentials in sinus rhythm or right ventricular pacing.