Anderson, Robert D., Nayyar, Sachin, Masse, Stephane, Lambiase, Pier D., and Nanthakumar, Kumaraswamy (2023) Wave tail mapping to guide ablation therapy for ventricular arrhythmias. Heart Rhythm, 20 (3). pp. 461-470.

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Abstract

The mainstays of antiarrhythmic treatment have consisted of lengthening repolarization, homogenizing repolarization, and modifying the excitable gap. Pharmacologic strategies of class 1 and 3 antiarrhythmic drugs utilize global therapeutic effects and are limited because targeting of specific ion channels at proarrhythmic sites has not been possible, leading to unwanted effects. Catheter-based therapies have mainly concentrated on depolarization and wavefront mapping, in particular the delay in activation, allowing treatment of selected regions of disease or arrhythmogenicity. Cardiac mapping for ventricular tachycardia (VT) therapy has focused on activation or wavefront mapping during VT. Other wavefront mapping, such as substrate-based approaches during sinus or paced rhythm, historically has been the preferred tool for localizing VT ablation targets. Techniques have been developed to locate prepotentials, Purkinje potentials, and late activation, as well as substrate methods such as local abnormal ventricular activity and decrement evoked potential mapping. All of these approaches rely on depolarization or wavefront, with no consideration of wave tail or local tissue repolarization.

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