Spatial analysis and characteristics of persistent late potentials after ablation of scar-related VT substrate: Implications for late potential elimination as a procedural endpoint with high-resolution mapping

Abstract

Background: Late potential (LP) elimination has been proposed as a surrogate endpoint for scar-related ventricular tachycardia (VT) ablation procedures. The characteristics, distribution, and predictors of persistent late potentials (pLPs) after ablation have not been studied.

Objective: The purpose of this study was to characterize the spatial distribution and features of pLP after catheter ablation of VT substrate with high-resolution mapping.

Methods: Cases of scar-related VT ablation with adequate pre- and postablation electroanatomic maps (EAMs) acquired exclusively using a high-density grid catheter were reviewed from 2021 to 2023.

Results: A total of 62 EAMs (pre- and postablation) from 31 cases using a high-density grid catheter were reviewed. pLPs were observed in 19 cases (61%) after ablation. New LP, spatially distinct from preablation LP, at the periphery of the ablation area comprised the majority of pLPs (16/19 [84%]). Isolated pLPs were more prevalent than fractionated pLPs, with a median amplitude of 0.26 mV (0.09-0.59 mV). The presence of pLP was associated with a significantly lower left ventricular ejection fraction (LVEF) and septal ablation but not low voltage, LP, or ablation area compared to absence of pLP (22.8% ± 7.8% vs 31.5% ± 8.0%, P = .008 for LVEF; 83% vs 44%, P = .033 for septal ablation).

Conclusion: Formation of spatially distinct new LP after targeted VT ablation is common, especially in patients with lower LVEF and septal substrate independent of ablation burden. This finding highlights the limitations of complete LP elimination as an endpoint to VT ablation procedures.

Keywords: Cardiomyopathy; High-resolution mapping; Late potentials; Multielectrode catheter; Ventricular tachycardia.