Substrate mapping for scar-related ventricular tachycardia in patients with resynchronization therapy-the importance of the pacing mode.

Baldinger, Samuel H.; Kumar, Saurabh; Fujii, Akira; Häberlin, Andreas; Romero, Jorge; Epstein, Laurence M; Michaud, Gregory F; Tedrow, Usha B; John, Roy; Stevenson, William G (2019). Substrate mapping for scar-related ventricular tachycardia in patients with resynchronization therapy-the importance of the pacing mode. Journal of interventional cardiac electrophysiology, 55(1), pp. 55-62. Springer 10.1007/s10840-019-00548-5

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PURPOSE Targets for substrate-based catheter ablation of scar-related ventricular tachycardia (VT) include sites with fractionated and late potentials (LPs). We hypothesized that in patients with cardiac resynchronization therapy (CRT), the pacing mode may influence the timing of abnormal electrograms (EGMs) relative to the surface QRS complex. METHODS We assessed bipolar EGM characteristics in left ventricular low bipolar voltage areas (< 1.5 mV) from 10 patients with coronary disease and a CRT device undergoing catheter ablation for VT. EGMs at 81 sites were analyzed during three different pacing modes (biventricular (BiV), right ventricular (RV)-only, and left ventricular (LV)-only) pacing. RESULTS Stimulus to end of local electrogram duration (Stim-to-eEGM) depended significantly on the stimulation site (BiV, LV, or RV, p = 0.032). Single-chamber pacing unmasked LPs, not present during BiV pacing, in three patients. In another three patients, a concomitant increase in stimulus to end of surface QRS duration caused by single-site pacing compensated for the increase in Stim-to-eEGM duration, thereby prohibiting LP unmasking. CONCLUSION The sequence of ventricular activation, as determined by the pacing site in patients with CRT devices, has a major influence on the detection of late potentials during substrate-guided ablation. Further study is warranted to define the optimal approaches, including the rhythm, for substrate mapping, but our findings suggest that BiV pacing may be most likely to obscure detection of late potentials as compared to single-site pacing.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Baldinger, Samuel Hannes and Häberlin, Andreas


600 Technology > 610 Medicine & health








Andreas David Heinrich Häberlin

Date Deposited:

08 Oct 2019 10:23

Last Modified:

24 Oct 2019 21:56

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Cardiac resynchronization therapy Catheter ablation Ischemic heart disease Substrate modification Ventricular tachycardia




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