Combination of High-Density and Coherent Mapping for Ablation of Ventricular Arrhythmia in Patients with Structural Heart Disease

Abstract

The present study describes our experience with a new mapping approach for ventricular arrhythmia (VA) ablation in patients with structural heart disease (SHD). Consecutive patients undergoing catheter ablation for recurrent VA were analyzed. High-density mapping was conducted in all patients. In patients with inducible VA, local activation time (LAT) mapping and a novel vector-based mapping algorithm were implemented to analyze arrhythmia propagation. In case of focal tachycardia, the location of earliest activation was targeted. In VAs with re-entrant mechanisms, zones of slow conduction based on coherent mapping were ablated. Substrate modification was performed when pathologic electrograms were identified. Seventy-four patients were included. Sixty-five patients (87.8%) were male. Ischemic cardiomyopathy was the underlying disease in 35 patients (47.3%) and nonischemic cardiomyopathy was the underlying disease in 39 patients (52.7%). Mean left ventricular ejection fraction was 33.8 ± 9.9%. Non-inducibility of any VA was achieved in 70 patients (94.6%). Termination of VA was achieved in 93.5% of patients with stable VA. In 4 patients (5.4%), partial success was achieved. VA (p < 0.001), ATP (p < 0.001) and shock burden (p = 0.001) were significantly reduced after ablation. Mean arrhythmia-free survival after 12 months was 85.1 ± 4.7%. High-density mapping in combination with coherent mapping may facilitate the understanding of the tachycardia mechanism, providing targets for effective ablation.