Arrhythmias & electrophysiology
Revisiting the link between substrate and ventricular tachycardia rate: The critical role of conduction-isthmus structure and function
Authors' conclusion
Conduction-isthmus properties predominate as determinants of VT rate. Quantitative characterization of VT-related conducting segments may support procedural planning in structural heart disease.
Study context
- Population
- Patients undergoing ablation for scar-related ventricular tachycardia (VT) who underwent high-density electroanatomic mapping and late gadolinium enhancement cardiac magnetic resonancepatients, 107 VT episodes analyzed
- Participants
- 62 patients
- Exposure
- global with isthmus-specific substrate features on VT rate
- fast VTn = 42
- Outcome
- fast VT defined as >180 beats/min
Main finding
As reported in the abstract
VT episodes classified as fast
39%
n = 42
Deceleration zone (DZ) duration of <110 ms, adjusted odds ratio
21.16; P < .001
Conduction channel (CC) length of <3 cm, adjusted odds ratio
10.18; P = .02
Observational data: associations, not effects.
Further findings
Discrimination for fast VT
- Area under the curve, DZ duration of <110 ms
- 0.88
- Area under the curve, CC length of <30 mm
- 0.89
- Area under the curve, late potential (LP) area of <20 cm²
- 0.79
- Global accuracy, each
- ≥80%
Structural-functional coupling: correlation of CC length
- With DZ duration
- ρ = 0.54
- With DZ area
- ρ = 0.35
- With LP area
- ρ = 0.55
- All P ≤ .01
Etiology
- Nonischemic cardiomyopathy had faster VT and a more compact isthmus than ischemic cardiomyopathy
- Etiology was not an independent predictor and did not modify isthmus-VT rate associations
Original publication
Revisiting the link between substrate and ventricular tachycardia rate: The critical role of conduction-isthmus structure and function. Heart Rhythm. Published 2 July 2026. doi:10.
Summarised from the published abstract; every number is checked against it