Pro-arrhythmogenicity of single-tip vs. multi-spline catheters in post-MI VT ablation: a prospective, international, two-center experience
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Background
Substrate mapping using multielectrode catheters is increasingly used for post-myocardial infarction (MI) ventricular tachycardia (VT) avoiding repeated VT induction and mapping during VT. However, these catheters may mechanically induce ventricular arrhythmias with hemodynamic compromise. This study compares pro-arrhythmogenicity between single-tip and multi-spline catheters during functional substrate mapping.
Methods
Thirty post-MI patients (age 68±8 years, 97% male, LVEF 40% [IQR 33–46]) referred for VT ablation at two centers (2021–2024) underwent endocardial mapping during baseline rhythm in random order with both a multi-spline catheter (Octaray™, n=4; Pentaray™, n=26) and a single-tip QDOT™ catheter. The protocol was prematurely terminated if (i) two mechanically induced VTs required ECV, (ii) recurrent ATP-treated mechanical VTs caused hemodynamic compromise, or (iii) excessive mechanically induced ectopy impaired catheter contact. Mapping time, point density, and mechanically induced arrhythmias were assessed.
Results
Multi-spline catheters enabled faster mapping (26±9 vs 60±16 minutes, p<0.001) with more acquired points (p<0.001). VTs were more frequently mechanically induced with multi-spline catheters (median 2 [IQR 1–4] vs 0 [0–3], p<0.05) and these VTs were faster (304ms, IQR 292–320] vs 373ms, IQR [316–405], p=0.01) and degenerated more often into VF (3 vs. 0). Overall, 17 patients (57%) experienced at least one mechanically induced VT; seven (23%) required cardioversion, and mapping was prematurely terminated in eight (27%), all while using multi-spline catheters.
Conclusion
Multi-spline catheters allow rapid substrate mapping but with substantial risk of mechanically induced arrhythmias, requiring premature termination of substrate mapping because of safety concerns. Their use in post-MI VT ablation warrants careful risk–benefit assessment.
Clinical perspectives
What is known
Substrate mapping using multielectrode catheters is increasingly used for post- myocardial infarction (MI) ventricular tachycardia (VT) avoiding repeated VT induction and mapping during VT.
However, these catheters may mechanically induce ventricular arrhythmias with hemodynamic compromise.
What this study adds
This is the first prospective, systematic comparison of incidence and characteristics of catheter induced ventricular arrhythmias between multi-spline and single-tip catheters during functional substrate mapping for post-myocardial infarction VT.
Multi-spline catheters were associated with a higher incidence of mechanically induced ventricular arrhythmias, including ventricular fibrillation, requiring premature termination of substrate mapping in more than a quarter of patients because of safety concerns.
Mapping with multi-spline catheters in VT-ablation warrant a careful risk-benefit assessment due to possible safety concerns over mechanically induced arrythmias.
