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Substrate Mapping and Ablation for Ventricular Tachycardia: The LAVA Approach
Author(s) -
SACHER FREDERIC,
LIM HAN S.,
DERVAL NICOLAS,
DENIS ARNAUD,
BERTE BENJAMIN,
YAMASHITA SEIGO,
HOCINI MÉLÈZE,
HAISSAGUERRE MICHEL,
JAÏS PIERRE
Publication year - 2015
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12565
Subject(s) - ablation , medicine , ventricular tachycardia , catheter ablation , lava , cardiology , sinus rhythm , tachycardia , substrate (aquarium) , radiology , atrial fibrillation , seismology , geology , volcano , oceanography
Substrate Mapping and Ablation Introduction Catheter ablation of ventricular tachycardia (VT) is proven effective therapy particularly in patients with frequent defibrillator shocks. However, the optimal endpoint for VT ablation has been debated and additional endpoints have been proposed. At the same time, ablation strategies aiming at homogenizing the substrate of scar‐related VT have been reported. Methods and Results Our method to homogenize the substrate consists of local abnormal ventricular activity (LAVA) elimination. LAVA are high‐frequency sharp signals that represent near‐field signals of slowly conducting tissue and hence potential VT isthmuses. Pacing maneuvers are sometimes required to differentiate them from far‐field signals. Delayed enhancement on cardiac MRI and/or wall thinning on multidetector computed tomography are also extremely helpful to identify the areas of interest during ablation.A strategy aiming at careful LAVA mapping, ablation, and elimination is feasible and can be achieved in about 70% of patients with scar‐related VT. Complete LAVA elimination is associated with a better outcome when compared to LAVA persistence even when VT is rendered noninducible. Conclusion This is a simple approach, with a clear endpoint and the ability to ablate in sinus rhythm. This strategy significantly benefits from high‐definition imaging, mapping, and epicardial access.