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Review
. 2024 Aug 24;13(17):5017.
doi: 10.3390/jcm13175017.

Approaching Ventricular Tachycardia Ablation in 2024: An Update on Mapping and Ablation Strategies, Timing, and Future Directions

Andrea Di Cori  1 , Lorenzo Pistelli  1 , Matteo Parollo  1 , Nicola Zaurino  2 , Luca Segreti  1 , Giulio Zucchelli  1
Affiliations
Review

Approaching Ventricular Tachycardia Ablation in 2024: An Update on Mapping and Ablation Strategies, Timing, and Future Directions

Andrea Di Cori et al. J Clin Med. .

Abstract

This review provides insights into mapping and ablation strategies for VT, offering a comprehensive overview of contemporary approaches and future perspectives in the field. The strengths and limitations of classical mapping strategies, namely activation mapping, pace mapping, entrainment mapping, and substrate mapping, are deeply discussed. The increasing pivotal relevance of CMR and MDCT in substrate definition is highlighted, particularly in defining the border zone, tissue channels, and fat. The integration of CMR and MDCT images with EAM is explored, with a special focus on their role in enhancing effectiveness and procedure safety. The abstract concludes by illustrating the Pisa workflow for the VT ablation procedure.

Keywords: artificial intelligence; cardiac magnetic resonance; computed tomography; electro-anatomical mapping; ventricular tachycardia; ventricular tachycardia ablation.

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Conflict of interest statement

Zaurino N. is employed by the company Johnson & Johnson Medial SpA. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Different approaches for VT ablation. (A) Bipolar voltage map of the left ventricle showing ablation tags according to the scar homogenization technique. (B) CMR-derived substrate map of the left ventricle obtained with ADAS3D processing (blue: healthy tissue; pink: border zone,; red: dense scar) showing heterogeneous tissue channels (in green) with ablation tags according to the CMR-guided scar dechannelling technique. VT: ventricular tachycardia; CMR: cardiac magnetic resonance.
Figure 2
Figure 2
(A) Epicardial isochronal LAT map showing delayed potentials at the mid-basal inferior/inferolateral wall. (B) LVWT MDCT showing thinned areas and the superimposed lipomatous metaplasia. (C) LGE-CMR processed with ADAS3D showing the epicardial scar and border zone areas with heterogeneous tissue channels (green). LAT: local activation mapping, LVWT: left ventricle wall thickness, MDCT: multi-detector computed tomography, LGE-CMR: late gadolinium enhancement cardiac magnetic resonance.
Figure 3
Figure 3
Pisa workflow for structural and nonstructural VT ablation. VT: Ventricular tachycardia, SHD: Structural heart disease, MDCT: Multi-detector computed tomography, LV: Left ventricle, WT: wall thickness, LGE-CMR: late gadolinium enhancement cardiac magnetic resonance, ENDO: Endocardium, EPI: Epicardium.
See this image and copyright information in PMC

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