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Background <p>Functional substrate mapping can identify ventricular tachycardia (VT) ablation targets. Multi-wavefront functional mapping can be laborious. In this study, we explored the feasibility, safety and utility of the new “parallel mapping” algorithm designed to streamline multi-wavefront activation mapping for VT.</p> Methods <p>This is a single center, prospective pilot study of adults undergoing scar-related VT ablation. Patients underwent endocardial and/or epicardial substrate parallel mapping using 2 distinct activation wavefronts (e.g. right ventricular [RV] and left ventricular [LV] pacing, 8 beats each). Slow-conducting regions were targeted for radiofrequency ablation. Short- and long-term outcomes were analyzed.</p> Results <p>Of the 41 ablation subjects, 19 (46.3%) underwent per-protocol parallel mapping. Protocol deviations mostly stemmed from incessant VT necessitating early ablation (<i>n</i> = 9, 40.9%). Most per-protocol treated subjects were male (<i>n</i> = 18, 94.7%) with a mean age of 66 ± 10 years and had a higher prevalence of ischemic heart disease compared to protocol deviations (94.7% vs. 54.6%, respectively, <i>p</i> = 0.005). Primary wavefront mapping was done during RV apical pacing. Secondary wavefront mapping chiefly relied on LV pacing (52.6%). The median procedure duration was 252&#xa0;min (IQR 190–289). Adverse events occurred in 4 patients (21.1%; at most 1 event directly related to study protocol). In the first year of follow-up, seven (36.8%) individuals received appropriate ICD shocks and three (15.8%) patients died. In exploratory analyses, parallel mapping data appeared most informative in subjects with lateral wall scar.</p> Conclusion <p>Parallel substrate mapping using multiple activation wavefronts is a novel, feasible and safe algorithm designed to identify ablation targets in patients with scar-related VT.</p> Graphical Abstract <p></p>

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PARALLEL-VT: A pilot study of simultaneous multi-wavefront left ventricular mapping for identification of critical ablation sites

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月6日

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  • Jakub Sroubek,
  • Mandeep Bhargava,
  • Koji Higuchi,
  • Ayman A. Hussein,
  • Niraj Varma,
  • Oussama M. Wazni,
  • Elad Anter

摘要

Background

Functional substrate mapping can identify ventricular tachycardia (VT) ablation targets. Multi-wavefront functional mapping can be laborious. In this study, we explored the feasibility, safety and utility of the new “parallel mapping” algorithm designed to streamline multi-wavefront activation mapping for VT.

Methods

This is a single center, prospective pilot study of adults undergoing scar-related VT ablation. Patients underwent endocardial and/or epicardial substrate parallel mapping using 2 distinct activation wavefronts (e.g. right ventricular [RV] and left ventricular [LV] pacing, 8 beats each). Slow-conducting regions were targeted for radiofrequency ablation. Short- and long-term outcomes were analyzed.

Results

Of the 41 ablation subjects, 19 (46.3%) underwent per-protocol parallel mapping. Protocol deviations mostly stemmed from incessant VT necessitating early ablation (n = 9, 40.9%). Most per-protocol treated subjects were male (n = 18, 94.7%) with a mean age of 66 ± 10 years and had a higher prevalence of ischemic heart disease compared to protocol deviations (94.7% vs. 54.6%, respectively, p = 0.005). Primary wavefront mapping was done during RV apical pacing. Secondary wavefront mapping chiefly relied on LV pacing (52.6%). The median procedure duration was 252 min (IQR 190–289). Adverse events occurred in 4 patients (21.1%; at most 1 event directly related to study protocol). In the first year of follow-up, seven (36.8%) individuals received appropriate ICD shocks and three (15.8%) patients died. In exploratory analyses, parallel mapping data appeared most informative in subjects with lateral wall scar.

Conclusion

Parallel substrate mapping using multiple activation wavefronts is a novel, feasible and safe algorithm designed to identify ablation targets in patients with scar-related VT.

Graphical Abstract