Clinical Research|Articles in Press

Utility of Substrate Mapping Using Extrasystole to Localise Comprehensive Ventricular Tachycardia Circuits: Results From Intra-operative Mapping Studies

Published:March 12, 2023DOI:



      Substrate mapping–based identification of all ventricular tachycardia (VT) circuits (diastolic activation), including partial and complete diastolic circuits in clinical and nonclinical VT, could be beneficial in guiding VT ablation to prevent VT recurrence. The utility of extrasystole induced late potentials has not been compared with late potentials in sinus rhythm (SR) and right ventricular pacing (RVp).


      Intraoperative simultaneous panoramic endocardial mapping of 21 VTs in 16 ischemic heart disease patients was performed with the use of a 112-bipole endocardial balloon. The decrement of near-field electrogram later than surface QRS during extrasystole (eLP) was studied.


      Patients had a mean age of 52 ± 9 years and were predominantly (75%) male. The mean sensitivity of eLP (0.75 [95% confidence interval [CI] 0.72-0.78]) to detect VT circuits was better than SR (0.33 [0.30-0.36]; P < 0.001) and RVp (0.36 [0.33-0.39]; P < 0.001) without significant differences in specificity, eLP (0.77 [0.74-0.81], SR (0.82 [0.80-0.84]; P = 0.23), and RVp (0.81 [0.78-0.83]; P = 0.11). Both negative (NPV) and positivie (PPV) predictive values were significantly better for eLP mapping. The mean NPV was 0.77 (95% CI 0.74-0.81), 0.57 (0.55-0.59), and 0.58 (0.55-0.61) for eLP, SR, and RVp, respectively (P < 0.0001). PPV was 0.75 (95% CI 0.72-0.78), 0.63 (0.59-0.67), and 0.63 (0.59-0.67) for eLP, SR, and RVp, respectively (P < 0.001). Overall diagnostic performance (area under the receiver operating characteristic curve) was significantly better for eLP (0.85 [95% CI 0.80-0.90] compared with SR (0.63 [0.56-0.72]; P < 0.001) or RVp (0.61 [0.52-0.74]; P < 0.001).


      Evoked late potential mapping is a better tool to detect comprehensive diastolic circuits activated during VT, compared with eLP mapping in sinus rhythm or RV pacing.



      L’identification de tous les circuits de tachycardie ventriculaire (activation diastolique), y compris les circuits diastoliques partiels et complets dans les cas de tachycardie ventriculaire (TV) clinique et non clinique, basée sur la cartographie des substrats, pourrait être utile pour guider l’ablation du foyer de la tachycardie ventriculaire afin d’en prévenir la récurrence. L’utilité des potentiels tardifs induits par l’extrasystole n’a pas été comparée aux potentiels tardifs dans le cas d’un rythme sinusal et d’une stimulation ventriculaire droite (SVD).


      Une cartographie endocardique panoramique simultanée peropératoire de 21 TV chez 16 patients atteints de cardiopathie ischémique a été réalisée à l’aide d’un ballon endocardique à 112 dipôles. On a étudié la diminution de l’ECG en champ proche après le QRS de surface pendant l’extrasystole (potentiels tardifs évoqués, ou PTe).


      Les patients étaient principalement des hommes (75 %) âgés en moyenne de 52 ± 9 ans. La sensibilité moyenne des PTe (0,75 [intervalle de confiance (IC) à 95 %, 0,72-0,78]) pour détecter les circuits de TV était meilleure que pour un rythme sinusal (0,33 [IC à 95 %, 0,30-0,36]; P < 0,001) et la SVD (0,36 [IC à 95 %, 0,33-0,39]; P < 0.001) sans différence significative sur le plan de la spécificité : PTe (0,77 [IC à 95 %, 0,74-0,81]), rythme sinusal (0,82 [IC à 95 %, 0,80-0,84]; P = 0,23) et SVD (0,81 [IC à 95 %, 0.78-0.83]; P = 0,11). La valeur prédictive négative (VPN) et la valeur prédictive positive (VPP) étaient significativement meilleures pour la cartographie des PTe. La VPN moyenne était respectivement de 0,77 (IC à 95 %, 0,74-0,81), de 0,57 (IC à 95 %, 0,55-0,59) et de 0,58 (IC à 95 %, 0,55-0,61) pour les PTe, le rythme sinusal et la SVD (P < 0,0001). La VPP était respectivement de 0,75 (IC à 95 %, 0,72-0,78), de 0,63 (IC à 95 %, 0,59-0,67) et de 0,63 (IC à 95 %, 0,59-0,67) pour les PTe, le rythme sinusal et la SVD (P < 0,001). La performance diagnostique globale (aire sous la courbe) était significativement meilleure pour les PTe (0,85 [IC à 95 %, 0,80-0,90]) que pour le rythme sinusal (0,63 [IC à 95 %, 0,56-0,72]; P < 0,001) ou la SVD (0,61 [IC à 95 %, 0,52-0,74]; P < 0,001).


      En comparaison de la cartographie des potentiels tardifs dans le cas d’un rythme sinusal ou d’une SVD, la cartographie des PTe est un meilleur outil pour détecter les circuits diastoliques activés pendant la tachycardie ventriculaire.

      Graphical abstract

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