Accuracy of Bipolar Amplitude Voltage Thresholds to Identify Late Potential Channels in Ventricular Tachycardia Ablation

Background: Ventricular tachycardia(VT) is caused by the presence of a slow conduction channel(CC) of border zone(BZ) tissue inside the scar-core tissue. Electroanatomic mapping can depict this tissue by voltage mapping. Areas of slow conduction can be detected as late potentials (LPs) and their abolition is the most accepted ablation endpoint. In current guidelines, bipolar voltage thresholds for BZ and core scar are 1.5 and 0.5mV respectively. The performance of these values is controversial. Purpose: To analyze the diagnostic yield of current amplitude thresholds in voltage map to define VT substrate in terms of CCs of LPs. Predictors of usefulness of current thresholds will be analyzed.Methods: All patients with structural heart disease who underwent VT ablation in Hospital Clinic in 2016-2017 were included. Maps with delineation of CCs based on LPs were created with contact-force sensor catheter. Thresholds were adjusted for every patient based on CCs. Diagnostic yield and predictors of performance of conventional thresholds were analyzed.ResultsDuring study period 57 consecutive patients were included (age:60,4+/-8,5; 50,2% ischemic cardiomyopathy, LVEF 39,8{plus minus}13.5%). Cut-off voltages that better identified the scar and BZ according LPs channels were 0,32(0,02-2 mV) and 1,84(0,3-6 mV) respectively. Current voltage thresholds identified correctly core and BZ in 87,7% and 42,1% of the patients respectively. Accuracy was worse in non-ischemic cardiomyopathy (NICM) especially for BZ (28,6% vs 55,2%,p=0,042)Conclusions: Accuracy of standard voltage thresholds for scar and BZ is poor in terms of LPs detection. Diagnostic yield is worse in NICM patients specially for border zone.