Arrhythmias & electrophysiology
Comparison of combined substrate-based mapping techniques to identify critical sites for ventricular tachycardia ablation
Authors' conclusion
ILAM, fractionation, and CV mapping each identified distinct critical sites and provided a smaller area of interest than did voltage mapping alone. The sensitivity of novel mapping modalities improved with greater local point density.
Study context
- Population
- Patients undergoing substrate mapping for ventricular tachycardia (VT) ablation with identified VT critical sites
- Participants
- 27 patients · 33 VT critical sites
- Exposure
- Substrate mapping techniques: bipolar voltage, omnipolar voltage, isochronal late activation mapping (ILAM), omnipolar CV, fractionation
- Outcome
- Identification of VT critical sites by each substrate mapping technique
Main finding
As reported in the abstract
Area of abnormality and critical sites encompassed
| Group | Value | Critical sites encompassed | Critical sites identified |
|---|---|---|---|
| Bipolar voltage | median 66 (IQR 41.3–86) cm² | all | |
| Omnipolar voltage | median 52 (IQR 37.7–65.5) cm² | all | |
| ILAM | median 9 (IQR 5.0–11.1) cm² | 22 (67%) | |
| CV | 10 (IQR 5.3–16.6) cm² | 22 (67%) | |
| Fractionation | median 4 (IQR 1.5–7.6) cm² | 20 (61%) |
Value
Bipolar voltagemedian 66 (IQR 41.3–86) cm²
Omnipolar voltagemedian 52 (IQR 37.7–65.5) cm²
ILAMmedian 9 (IQR 5.0–11.1) cm²
CV10 (IQR 5.3–16.6) cm²
Fractionationmedian 4 (IQR 1.5–7.6) cm²
Critical sites encompassed
Bipolar voltageall
Omnipolar voltageall
ILAM22 (67%)
CVNot reported in the abstract
Fractionation20 (61%)
Critical sites identified
Bipolar voltageNot reported in the abstract
Omnipolar voltageNot reported in the abstract
ILAMNot reported in the abstract
CV22 (67%)
FractionationNot reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | Values |
|---|---|
| Mapping yield | Fractionation + CV 2.1 critical sites/cm² · Bipolar voltage 0.5 critical sites/cm² |
| CV sensitivity at local point density >50 points/cm² | CV 100% |
Mapping yield
- Yield highest for fractionation + CV, least for bipolar voltage
Original publication
Comparison of combined substrate-based mapping techniques to identify critical sites for ventricular tachycardia ablation. Heart Rhythm. Published 28 February 2023. doi:10.
Summarised from the published abstract; every number is checked against it