Impact of different activation wavefronts on ischemic myocardial scar electrophysiological properties during high‐density ventricular tachycardia mapping and ablation

Gustavo Lima da Silva (1, 2) , Nuno Cortez‐dias (1, 2) , Afonso Nunes Ferreira (1, 2) , Elad Nakar (3) , Raquel Francisco (3) , Mariana Pereira (3) , Javier Moreno (4) , Raphaël P Martins (5, 6) , Fausto J Pinto (2) , João de Sousa (2)

1 CHULN - Centro Hospitalar Universitário Lisboa Norte [Lisbon, Portugal]
2 Universidade de Lisboa
3 Johnson & Johnson Corporation
4 Hospital Universitario Ramón y Cajal [Madrid]
5 CHU Pontchaillou [Rennes]
6 LTSI - Laboratoire Traitement du Signal et de l'Image

Introduction: Scar-related ventricular tachycardia (VT) usually results from an underlying reentrant circuit facilitated by anatomical and functional barriers. The later are sensitive to the direction of ventricular activation wavefronts. We aim to evaluate the impact of different ventricular activation wavefronts on the functional electrophysiological properties of myocardial tissue. Methods: Patients with ischemic heart disease referred for VT ablation underwent high-density mapping using Carto®3 (Biosense Webster). Maps were generated during sinus rhythm, right and left ventricular pacing, and analyzed using a new late potential map software, which allows to assess local conduction velocities and facilitates the delineation of intra-scar conduction corridors (ISCC); and for all stable VTs. Results: In 16 patients, 31 high-resolution substrate maps from different ventricular activation wavefronts and 7 VT activation maps were obtained. Local abnormal ventricular activities (LAVAs) were found in VT isthmus, but also in noncritical areas. The VT isthmus was localized in areas of LAVAs overlapping surface between the different activation wavefronts. The deceleration zone location differed depending on activation wavefronts. Sixty-six percent of ISCCs were similarly identified in all activating wavefronts, but the one acting as VT isthmus was simultaneously identified in all activation wavefronts in all cases. Conclusion: Functional based substrate mapping may improve the specificity to localize the most arrhythmogenic regions within the scar, making the use of different activation wavefronts unnecessary in most cases.

Keywords: ablation; conduction velocity; mapping; ventricular tachycardia; wavefront

Domains: Life Sciences [q-bio]; Human health and pathology; Cardiology and cardiovascular system

Gustavo Lima da Silva, Nuno Cortez‐dias, Afonso Nunes Ferreira, Elad Nakar, Raquel Francisco, et al.. Impact of different activation wavefronts on ischemic myocardial scar electrophysiological properties during high‐density ventricular tachycardia mapping and ablation. Journal of Cardiovascular Electrophysiology, 2022, ⟨10.1111/jce.15740⟩. ⟨hal-03956186⟩