Endocardial Substrate Mapping for Monomorphic Ventricular Tachycardia Ablation in Ischemic and Non-Ischemic Cardiomyopathy

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We investigated the differences in the endocardial substrates between ischemiccardiomyopathy (ICM) and non-ICM (NICM) by using electro-anatomical mappingand pace-mapping. We studied 18 patients (ICM and NICM, 9 each) withmonomorphic ventricular tachycardia (VT) documented by 12-leads ECG. Low voltagearea was defined by signal amplitude <1.5 mV. A pace-map QRS morphology thatmatched VT in >10 of the 12-leads ECG was regarded as a pace-map match. Andconduction delay during pace-mapping was defined as the stimulus to QRS interval ≥40ms. Low voltage area was 53.8 ± 21.5 and 20.8 ± 16.7 cm2 in ICM and NICM patients,respectively (P = 0.002). Pace-mapping was assessed in 6 ICM and 9 NICM. Pace-mapmatch with conduction delay were obtained in all the 6 ICM patients. But in NICMpatients, pace-map match with conduction delay was obtained in 3 patients. Pace-mapmatch sites where conduction delay was not observed were obtained in 5 patients.Pace-map match could not be obtained in 1 patient. We attempted ablation in 6 ICMand 7 NICM patients. Subsequently, VT recurrence was not observed in ICM but itwas observed in 6 of 7 NICM patients (log-rank P = 0.0016). In NICM patients, thearrhythmogenic substrate that represented the abnormal electrogram and conductiondelay was observed less within the endocardial surface when compared with thatobserved in ICM. VT recurrence rate subsequent to endocardial ablation was higher inNICM than in ICM patients.
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Endocardial Substrate Mapping for Monomorphic Ventricular Tachycardia Ablation in Ischemic and Non-Ischemic Cardiomyopathy

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