Understanding Functional Substrate Mapping Techniques In VT Ablation To Improve Outcomes
Overview
Mapping and ablation of post-infarct related ventricular tachycardia (VT) remains a challenge. Conventional activation and entrainment methods are limited by poorly tolerated VT’s, multiple VT’s, complex circuits and the deleterious effects of mapping in VT on cardiac, renal and cerebral function. The resultant effect is poor long term outcomes.
Classical substrate mapping techniques predominantly involve mapping ventricular scar substrate in intrinsic rhythm, however, VT circuits may be dynamic, and substrate characteristics may not be static or prevalent in intrinsic rhythm. Emerging functional substrate assessment methods of VT ablation may improve outcomes from VT ablation and may be safer by reducing the need for the patient to be in VT for prolonged periods of time.
This webinar discusses presently available techniques.
Key References
1. Porta-Sánchez A, et al. Multicenter Study of Ischemic Ventricular Tachycardia Ablation With Decrement-Evoked Potential (DEEP) Mapping With Extra Stimulus. JACC Clin Electrophysiol. 2018 Mar;4(3):307-315.
2. Srinivasan NT, et al. Multicenter Study of Dynamic High-Density Functional Substrate Mapping Improves Identification of Substrate Targets for Ischemic Ventricular Tachycardia Ablation. JACC Clin Electrophysiol. 2020 Dec, 6 (14) 1783–1793
3. Anter E, et al. Ablation of Reentry-Vulnerable Zones Determined by Left Ventricular Activation From Multiple Directions: A Novel Approach for Ventricular Tachycardia Ablation. Circ Arrhythm Electrophysiol. 2020 Jun;13(6)
Learning Objectives
- Understanding the limitations of conventional VT approaches
- Understanding the rationale for functional substrate assessment
- How to Practically Perform DeEP mapping
- How to practically perform SENSE PROTOCOL mapping
- Understand how hidden slow conduction identification improves outcomes
Target Audience
- Cardiac Electrophysiologists
- Nurses
- Cardiac Physiologists
- Technicians
