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Background <p>Ablation of ventricular arrhythmias (VA) relies on accurate electroanatomical mapping (EAM) to identify critical reentry circuit sites. Analysis of local peak frequency (PF) and Vector Field Disarray (VFD) may serve as useful metrics to improve EAM accuracy.</p> Methods <p>We retrospectively analyzed high-density EAM data from consecutive patients who underwent VT ablation using the EnSite X System with Advisor HD Grid catheter at our institution. PF and VFD distributions were analyzed for co-localization with conventional substrate markers and activation-mapped VT isthmus sites. The diagnostic accuracy of PF for identifying VT isthmus sites was assessed using mixed-effects models and ROC analysis.</p> Results <p>Sixty maps from 34 patients (70.5 years, 52.9% ischemic) were analyzed. Within low-voltage areas, median PF was 280&#xa0;Hz and VFD 60%. At baseline, VT isthmus sites had higher PF than non-isthmus sites (372 ± 96 vs. 247 ± 84&#xa0;Hz, <i>p</i> &lt; 0.0001), with 16% higher odds of isthmus presence per 10-Hz increase (OR 1.016, <i>p</i> &lt; 0.0001, AUC 0.849). A 315&#xa0;Hz threshold provided an accuracy of 78% (sensitivity 72%, specificity 84%) in identification of isthmus areas. Post-ablation PF decreased to 123 ± 42&#xa0;Hz (<i>p</i> &lt; 0.0001).</p> Conclusion <p>Analysis of PF and VFD may enhance the identification of VT critical isthmus sites by improving near-field signal annotation and detecting wavefront collision zones. These metrics should be considered as a complementary tool to conventional EAM.</p> Graphical abstract <p></p>

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Near-field substrate analysis in ventricular tachycardia: a novel approach to identify the critical isthmus

  • 期刊论文

  • 发表日期：

    2026年5月12日

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  • Federica Giordano,
  • Federico Ballacci,
  • Chiara Pavone,
  • Ambra Del Greco,
  • Roberto Scacciavillani,
  • Gaetano Pinnacchio,
  • Gianluigi Bencardino,
  • Francesco Perna,
  • Gianluca Comerci,
  • Massimo Imazio,
  • Maria Lucia Narducci,
  • Gemma Pelargonio

摘要

Background

Ablation of ventricular arrhythmias (VA) relies on accurate electroanatomical mapping (EAM) to identify critical reentry circuit sites. Analysis of local peak frequency (PF) and Vector Field Disarray (VFD) may serve as useful metrics to improve EAM accuracy.

Methods

We retrospectively analyzed high-density EAM data from consecutive patients who underwent VT ablation using the EnSite X System with Advisor HD Grid catheter at our institution. PF and VFD distributions were analyzed for co-localization with conventional substrate markers and activation-mapped VT isthmus sites. The diagnostic accuracy of PF for identifying VT isthmus sites was assessed using mixed-effects models and ROC analysis.

Results

Sixty maps from 34 patients (70.5 years, 52.9% ischemic) were analyzed. Within low-voltage areas, median PF was 280 Hz and VFD 60%. At baseline, VT isthmus sites had higher PF than non-isthmus sites (372 ± 96 vs. 247 ± 84 Hz, p < 0.0001), with 16% higher odds of isthmus presence per 10-Hz increase (OR 1.016, p < 0.0001, AUC 0.849). A 315 Hz threshold provided an accuracy of 78% (sensitivity 72%, specificity 84%) in identification of isthmus areas. Post-ablation PF decreased to 123 ± 42 Hz (p < 0.0001).

Conclusion

Analysis of PF and VFD may enhance the identification of VT critical isthmus sites by improving near-field signal annotation and detecting wavefront collision zones. These metrics should be considered as a complementary tool to conventional EAM.

Graphical abstract