Substrate Mapping and Ablation for Ventricular Tachycardia in Patients with Structural Heart Disease: How to Identify Ventricular Tachycardia Substrate.

Catheter ablation for ventricular tachycardia (VT) has been increasingly used over the past two decades in patients with structural heart disease (SHD). In these individuals, a substrate mapping strategy is being more commonly applied to identify targets for VT ablation, which has been shown to be more effective versus targeting mappable VTs alone. There are a number of substrate mapping methods in existence that aim to explore potential VT isthmuses, although their success rates vary. Most of the reported electrogram-based mapping studies have been performed with ablation catheters; meanwhile, the use of multipolar mapping catheters with smaller electrodes and closer interelectrode spacing has emerged, which allows for an assessment of detailed near-field abnormal electrograms at a higher resolution. Another recent advancement has occurred in the use of imaging techniques in VT ablation, particularly in refining the substrate. The goal of this paper is to review the key developments and limitations of current mapping strategies of substrate-based VT ablation and their outcomes. In addition, we briefly summarize the role of cardiac imaging in delineating VT substrate.

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Copyright: © 2019 Innovations in Cardiac Rhythm Management.

Déclaration de conflit d'intérêts

Dr. Denis and Dr. Derval have received speaking honoraria and consulting fees from Boston Scientific. Dr. Hocini, Dr. Haïssaguerre, and Dr. Jaïs have received lecture fees from Abbott and Biosense Webster. Dr. Sacher has received consulting fees and speaking honorarium from Abbott, Boston Scientific, Medtronic, and Biosense Webster. The other authors report no conflicts of interest for the published content. This research was supported by an ANR grant (IHU LIRYC grant no. ANR-10-IAHU-04).