Understanding the Significance and Approach to Ventricular Tachycardia Ablation of Scar-related Border Zones

de Riva M, Naruse Y, Ebert M, et al. Targeting the Hidden Substrate Unmasked by Right Ventricular Extrastimulation Improves Ventricular Tachycardia Ablation Outcome After Myocardial Infarction. JACC Clin Electrophysiol. 2018;4(3):316–27. https://doi.org/10.1016/j.jacep.2018.01.013.

Article  PubMed  Google Scholar 

Marchlinski FE, Callans DJ, Gottlieb CD, Zado E. Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy. Circulation. 2000;101(11):1288–96. https://doi.org/10.1161/01.cir.101.11.1288.

Article  CAS  PubMed  Google Scholar 

Josephson ME, Anter E. Substrate Mapping for Ventricular Tachycardia: Assumptions and Misconceptions. JACC Clin Electrophysiol. 2015;1(5):341–52. https://doi.org/10.1016/j.jacep.2015.09.001.

Article  PubMed  Google Scholar 

Dickfeld T, Tian J, Ahmad G, et al. MRI-Guided ventricular tachycardia ablation: integration of late gadolinium-enhanced 3D scar in patients with implantable cardioverter-defibrillators. Circ Arrhythm Electrophysiol. 2011;4(2):172–84. https://doi.org/10.1161/CIRCEP.110.958744.

Article  PubMed  Google Scholar 

Hsia HH, Callans DJ, Marchlinski FE. Characterization of endocardial electrophysiological substrate in patients with nonischemic cardiomyopathy and monomorphic ventricular tachycardia. Circulation. 2003;108(6):704–10. https://doi.org/10.1161/01.CIR.0000083725.72693.EA.

Article  PubMed  Google Scholar 

Soejima K, Stevenson WG, Sapp JL, Selwyn AP, Couper G, Epstein LM. Endocardial and epicardial radiofrequency ablation of ventricular tachycardia associated with dilated cardiomyopathy: the importance of low-voltage scars. J Am Coll Cardiol. 2004;43(10):1834–42. https://doi.org/10.1016/j.jacc.2004.01.029.

Article  PubMed  Google Scholar 

Brunckhorst CB, Delacretaz E, Soejima K, Maisel WH, Friedman PL, Stevenson WG. Impact of changing activation sequence on bipolar electrogram amplitude for voltage mapping of left ventricular infarcts causing ventricular tachycardia. J Interv Card Electrophysiol. 2005;12(2):137–41. https://doi.org/10.1007/s10840-005-6549-z.

Article  PubMed  Google Scholar 

Bogun FM, Desjardins B, Good E, Gupta S, Crawford T, Oral H, Ebinger M, Pelosi F, Chugh A, Jongnarangsin K, Morady F. Delayed-enhanced magnetic resonance imaging in nonischemic cardiomyopathy: utility for identifying the ventricular arrhythmia substrate. J Am Coll Cardiol. 2009;53(13):1138–45. https://doi.org/10.1016/j.jacc.2008.11.052.

Article  PubMed  PubMed Central  Google Scholar 

Thajudeen A, Jackman WM, Stewart B, Cokic I, Nakagawa H, Shehata M, Amorn AM, Kali A, Liu E, Harlev D, Bennett N, Dharmakumar R, Chugh SS, Wang X. Correlation of scar in cardiac MRI and high-resolution contact mapping of left ventricle in a chronic infarct model. Pacing Clin Electrophysiol. 2015;38(6):663–74. https://doi.org/10.1111/pace.12581.

Article  PubMed  PubMed Central  Google Scholar 

Vergara P, Trevisi N, Ricco A, Petracca F, Baratto F, Cireddu M, Bisceglia C, Maccabelli G, Della BP. Late potentials abolition as an additional technique for reduction of arrhythmia recurrence in scar related ventricular tachycardia ablation. J Cardiovasc Electrophysiol. 2012;23(6):621–7. https://doi.org/10.1111/j.1540-8167.2011.02246.x.

Article  PubMed  Google Scholar 

Tung R, Mathuria NS, Nagel R, Mandapati R, Buch EF, Bradfield JS, Vaseghi M, Boyle NG, Shivkumar K. Impact of local ablation on interconnected channels within ventricular scar: mechanistic implications for substrate modification. Circ Arrhythm Electrophysiol. 2013;6(6):1131–8. https://doi.org/10.1161/CIRCEP.113.000867.

Article  PubMed  PubMed Central  Google Scholar 

Aziz Z, Shatz D, Raiman M, Upadhyay GA, Beaser AD, Besser SA, Shatz NA, Fu Z, Jiang R, Nishimura T, Liao H, Nayak HM, Tung R. Targeted Ablation of Ventricular Tachycardia Guided by Wavefront Discontinuities During Sinus Rhythm: A New Functional Substrate Mapping Strategy. Circulation. 2019;140(17):1383–97. https://doi.org/10.1161/CIRCULATIONAHA.119.042423.

Article  PubMed  Google Scholar 

Jackson N, Gizurarson S, Viswanathan K, King B, Massé S, Kusha M, Porta-Sanchez A, Jacob JR, Khan F, Das M, Ha AC, Pashaei A, Vigmond E, Downar E, Nanthakumar K. Decrement Evoked Potential Mapping: Basis of a Mechanistic Strategy for Ventricular Tachycardia Ablation. Circ Arrhythm Electrophysiol. 2015;8(6):1433–42. https://doi.org/10.1161/CIRCEP.115.003083.

Article  PubMed  Google Scholar 

Porta-Sánchez A, Jackson N, Lukac P, Kristiansen SB, Nielsen JM, Gizurarson S, Massé S, Labos C, Viswanathan K, King B, Ha ACT, Downar E, Nanthakumar K. Multicenter Study of Ischemic Ventricular Tachycardia Ablation With Decrement-Evoked Potential (DEEP) Mapping With Extra Stimulus. JACC Clin Electrophysiol. 2018;4(3):307–15. https://doi.org/10.1016/j.jacep.2017.12.005.

Article  PubMed  Google Scholar 

Guichard JB, Regany-Closa M, Vazquez-Calvo S, Zazu B, Pellicier-Senda B, Serrano-Campaner J, Molero-Pereria S, Borras R, Ortiz JT, Falzone PV, Eugolio F, Reventos-Presmanes J, Garre P, Arbelo E, Althoff TF, Guasch E, Tolosana JM, Grugada J, Mont L, Porta-Sanchez A, Roca-Luque I. Improving Substrate Mapping for Ventricular Tachycardia Ablation through High-Density and Whole-Chamber Double Extra Stimuli Protocol. JACC EP. 2024 https://doi.org/10.1016/j.jacep.2024.04.023

Polin GM, Haqqani H, Tzou W, Hutchinson MD, Garcia FC, Callans DJ, Zado ES, Marchlinski FE. Endocardial unipolar voltage mapping to identify epicardial substrate in arrhythmogenic right ventricular cardiomyopathy/dysplasia. Heart Rhythm. 2011;8(1):76–83. https://doi.org/10.1016/j.hrthm.2010.09.088.

Article  PubMed  Google Scholar 

Tokuda M, Tedrow UB, Inada K, Reichlin T, Michaud GF, John RM, Epstein LM, Stevenson WG. Direct comparison of adjacent endocardial and epicardial electrograms: implications for substrate mapping. J Am Heart Assoc. 2013;2:e000215. https://doi.org/10.1161/JAHA.113.000215.

Article  PubMed  PubMed Central  Google Scholar 

Venlet J, Piers SRD, Kapel GFL, de Riva M, Pauli PFG, van der Geest RJ, Zeppenfeld K. Unipolar Endocardial Voltage Mapping in the Right Ventricle: Optimal Cutoff Values Correcting for Computed Tomography-Derived Epicardial Fat Thickness and Their Clinical Value for Substrate Delineation. Circ Arrhythm Electrophysiol. 2017;10(8):e005175. https://doi.org/10.1161/CIRCEP.117.005175.

Article  PubMed  Google Scholar 

Hoogendoorn JC, Venlet J, de Riva M, Wijnmaalen AP, Piers SRD, Zeppenfeld K. Unipolar voltage mapping in right ventricular cardiomyopathy: pitfalls, solutions and advantages. Europace. 2023;25(3):1035–40. https://doi.org/10.1093/europace/euac278. (Erratum In: Europace. 2023 May 19;25(5)).

Article  PubMed  PubMed Central  Google Scholar 

Hutchinson MD, Gerstenfeld EP, Desjardins B, Bala R, Riley MP, Garcia FC, Dixit S, Lin D, Tzou WS, Cooper JM, Verdino RJ, Callans DJ, Marchlinski FE. Endocardial unipolar voltage mapping to detect epicardial ventricular tachycardia substrate in patients with nonischemic left ventricular cardiomyopathy. Circ Arrhythm Electrophysiol. 2011;4(1):49–55. https://doi.org/10.1161/CIRCEP.110.959957.

Article  PubMed  Google Scholar 

Hoogendoorn JC, Sramko M, Venlet J, Siontis KC, Kumar S, Singh R, Nakajima I, Piers SRD, de Riva SM, Glashan CA, Crawford T, Tedrow UB, Stevenson WG, Bogun F, Zeppenfeld K. Electroanatomical Voltage Mapping to Distinguish Right-Sided Cardiac Sarcoidosis From Arrhythmogenic Right Ventricular Cardiomyopathy. JACC Clin Electrophysiol. 2020;6(6):696–707. https://doi.org/10.1016/j.jacep.2020.02.008.

Article  PubMed  Google Scholar 

Soto-Becerra R, Bazan V, Bautista W, Malavassi F, Altamar J, Ramirez JD, Everth A, Callans DJ, Marchlinski FE, Rodríguez D, García FC, Sáenz LC. Ventricular Tachycardia in the Setting of Chagasic Cardiomyopathy: Use of Voltage Mapping to Characterize Endoepicardial Nonischemic Scar Distribution. Circ Arrhythm Electrophysiol. 2017;10(11):e004950. https://doi.org/10.1161/CIRCEP.116.004950.

Article  PubMed  Google Scholar 

Oloriz T, Silberbauer J, Maccabelli G, Mizuno H, Baratto F, Kirubakaran S, Vergara P, Bisceglia C, Santagostino G, Marzi A, Sora N, Roque C, Guarracini F, Tsiachris D, Radinovic A, Cireddu M, Sala S, Gulletta S, Paglino G, Mazzone P, Trevisi N, Della BP. Catheter ablation of ventricular arrhythmia in nonischemic cardiomyopathy: anteroseptal versus inferolateral scar sub-types. Circ Arrhythm Electrophysiol. 2014;7(3):414–23. https://doi.org/10.1161/CIRCEP.114.001568.

Article  PubMed  Google Scholar 

Colli-Franzone P, Gionti V, Pavarino LF, Scacchi S, Storti C. Role of infarct scar dimensions, border zone repolarization properties and anisotropy in the origin and maintenance of cardiac reentry. Math Biosci. 2019;315:108228. https://doi.org/10.1016/j.mbs.2019.108228.

Article  CAS  PubMed  Google Scholar 

Verma A, Marrouche NF, Schweikert RA, Saliba W, Wazni O, Cummings J, Abdul-Karim A, Bhargava M, Burkhardt JD, Kilicaslan F, Martin DO, Natale A. Relationship between successful ablation sites and the scar border zone defined by substrate mapping for ventricular tachycardia post-myocardial infarction. J Cardiovasc Electrophysiol. 2005;16(5):465–71. https://doi.org/10.1046/j.1540-8167.2005.40443.x.

Article  PubMed  Google Scholar 

Hsia HH, Lin D, Sauer WH, Callans DJ, Marchlinski FE. Anatomic characterization of endocardial substrate for hemodynamically stable reentrant ventricular tachycardia: identification of endocardial conducting channels. Heart Rhythm. 2006;3(5):503–12. https://doi.org/10.1016/j.hrthm.2006.01.015.

Article  PubMed  Google Scholar 

Stevenson WG. Ventricular scars and ventricular tachycardia. Trans Am Clin Climatol Assoc. 2009;120:403–12.

PubMed  PubMed Central  Google Scholar 

Bazan V, Frankel DS, Santangeli P, Garcia FC, Tschabrunn CM, Marchlinski FE. Three-dimensional myocardial scar characterization from the endocardium: Usefulness of endocardial unipolar electroanatomic mapping. J Cardiovasc Electrophysiol. 2019;30(3):427–37. https://doi.org/10.1111/jce.13842.

Article  PubMed 

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