Abstract
Background: During ventricular catheter mapping to guide catheter ablation of scar-related ventricular tachycardia (VT), creating an electroanatomical map can be frustrated by catheter-induced ventricular ectopy. However, we observed anecdotally that catheter-induced ventricular ectopy may unmask local abnormal ventricular activities (LAVA). The aim of this study was to compare LAVA characteristics between catheter-induced ventricular ectopy and intrinsic ventricular conduction in post-infarction patients undergoing electroanatomic mapping. Methods: We performed a retrospective review of electroanatomical maps from 136 consecutive post-infarction VT patients who had undergone mapping using a contact force-sensing catheter (Thermocool STSF & CARTO, Biosense Webster Inc). Patients who had any diagnostic catheters inside the ventricular were excluded. From 8 patients, 1154 discrete points were screened during sinus rhythm or right atrial pacing, and 443 points were identified to have ectopic and intrinsic beats - confirmed to be colocalized using show-catheter functionality. Results: Among 443 points, LAVA were identified in 151 points - either during catheter-induced ectopy or intrinsic rhythm. The interval from onset of QRS to ventricular electrogram (EGM) were measured: ectopy revealed negative values compared to intrinsic rhythm (-43.5 (-65.5, 0) vs 18.5 (0, 35.0), P<0.001). Catheter-induced ectopy had significantly longer EGM duration (206.0ms (161.0, 285.0) vs 140.0 (123.8, 168.3), P<0.001) and smaller EGM amplitude (0.59mV (0.34, 0.82) vs 0.66 (0.36, 1.06), P=0.003) compared to intrinsic rhythm. For 77 of 151 (51.0%) points, LAVA potentials were unmasked only during catheter-induced ectopy. Conclusions: During mapping of infarcted ventricles, catheter-induced ectopy offers potential insights into the underlying tissue, warranting further investigation as a guide to VT ablation.
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