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. 2017 Aug;6(3):118-124.
doi: 10.15420/aer.2017.20.1.

Limitations and Challenges in Mapping Ventricular Tachycardia: New Technologies and Future Directions

Adam J Graham  1 , Michele Orini  1   2 , Pier D Lambiase  1   2
Affiliations

Limitations and Challenges in Mapping Ventricular Tachycardia: New Technologies and Future Directions

Adam J Graham et al. Arrhythm Electrophysiol Rev. 2017 Aug.

Abstract

Recurrent episodes of ventricular tachycardia in patients with structural heart disease are associated with increased mortality and morbidity, despite the life-saving benefits of implantable cardiac defibrillators. Reducing implantable cardiac defibrillator therapies is important, as recurrent shocks can cause increased myocardial damage and stunning, despite the conversion of ventricular tachycardia/ventricular fibrillation. Catheter ablation has emerged as a potential therapeutic option either for primary or secondary prevention of these arrhythmias, particularly in post-myocardial infarction cases where the substrate is well defined. However, the outcomes of catheter ablation of ventricular tachycardia in structural heart disease remain unsatisfactory in comparison with other electrophysiological procedures. The disappointing efficacy of ventricular tachycardia ablation in structural heart disease is multifactorial. In this review, we discuss the issues surrounding this and examine the limitations of current mapping approaches, as well as newer technologies that might help address them.

Keywords: Ventricular tachycardia; arrhythmia; cardiomyopathy; catheters; ripple mapping; substrate mapping.

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Conflict of interest statement

Disclosure: Pier D Lambiase receives speaker fees, educational grants and research grants from Medtronic and Boston Scientific.

Figures

Figure 1:
Figure 1:. Example of Concealed Entrainment from the Middle of the VT Isthmus in a Patient with IHD
Figure 2:
Figure 2:. Bipolar Voltage of Epicardial Substrate in Patient with ARVC in LAO Projection
Figure 3:
Figure 3:. Wideband Cardiac MRI Showing Inferolateral Scar (left). Image on the Right is Prior to Application of Wideband Technology to Remove the Artefact Caused by the ICD Generator
Figure 4:
Figure 4:. Orion Basket Catheter Used with the RHYTHMIA System, Containing 64×0.4 mm2 Electrodes with 2.5 mm Centre-to-centre Spacing to Enable Higher-resolution Mapping
Figure 5:
Figure 5:. High-resolution Mapping of Sustained Monomorphic VT (right) and Electrograms from the Roving Catheter (left)
Figure 6:
Figure 6:. Posterior–anterior View of Epicardial Bipolar Voltage Map (left) Showing Extensive Epicardial Scar. Posterior–anterior View of ECG–I Map (CardioInsight system, Medtronic) Showing Site of Earliest Activation (Earliest White) of Ventricular Tachycardia in the Same Patient
See this image and copyright information in PMC

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