New York Medical College
The goal of this study is to map conducting channels within scar that cause ventricular tachycardia (VT) in patients with scar in their hearts in order to block these channels from causing VT with targeted radiofrequency ablation (cautery). Participants undergoing VT ablation mapping of these channels by pacing many sites within the scar area and determining where these channels exit the scar into normal tissue. These exits will be ablated. Immediate success and success at 1 year will be evaluated.
After standard VT induction and mapping procedures (noninvasive identification of induced VT exit sites with Vektor vMap; substrate mapping; initial pacemapping), the study will consist of pacing within the substrate and mapping all channel exits both noninvasively with vMap as well as invasively with high density mapping catheters within the heart by escape mapping (all paced sites creating a consistent paced morphology, up to the shortest stimulus-to-QRS interval achieved) as well as focal activation mapping of this channel exit while pacing within the channel. The noninvasive map will aid i…
Inclusion Criteria: * Patients with structural heart disease undergoing VT ablation Exclusion Criteria: 1. Unable or unwilling to sign consent 2. Cardiogenic shock or NYHA Class IV heart failure and not a candidate for mechanical circulatory support for the procedure (percutaneous left ventricular assist device (LVAD), extracorporeal membrane oxygenation, or implanted LVAD) 3. Absence of substrate during initial voltage mapping
Ablation will be guided by mapping the substrate "from the inside out" by identifying conducting channels as they might be activated during VT. Extensive pace mapping will be performed within scar areas identified during sinus rhythm mapping. The course of these channels will be identified and ablated across the distal portion, just proximal to the exit based on shortest stimulus-to-QRS interval obtained.
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