Ventricular mapping using a contact force-sensing catheter demonstrated higher median contact force in the left and right endocardium (15 g and 13 g) compared to the epicardium (8 g, P<0.001).
Observational (n=21)
How does contact force vary across different ventricular regions and mapping approaches during ventricular tachycardia substrate mapping?
Ventricular mapping shows significant regional variations in contact force, with higher forces achieved endocardially and improved contact in specific left ventricular regions using a transseptal approach.
p-value: p=<0.001
BACKGROUND: The optimal contact force (CF) for ventricular mapping and ablation remains unvalidated. We assessed CF in different endocardial and epicardial regions during ventricular tachycardia substrate mapping using a CF-sensing catheter (Smartouch; Biosense-Webster) and compared the transseptal versus retroaortic approach. METHODS AND RESULTS: In total, 8979 mapping points with CF, and force vector orientation (VO) were recorded in 21 patients, comprising 13 epicardial, 12 left ventricular (6 transseptal and 6 retroaortic approach), and 12 right ventricular endocardial maps. VO was defined as adequate when the vector was directed toward the myocardium. During epicardial mapping, 46% of the points showed an adequate VO and a median CF of 8 (4-13) g, however, with significant differences among the 8 regions. When VO was inadequate, median CF was higher at 16 (10-24) g (P<0.0001). During left ventricular and right ventricular endocardial mapping, 94% of VO were adequate. Median CF of adequate VO was higher in the left ventricular and right ventricular endocardium than in the epicardium (15 8-25 and 13 7-22 g versus 8 4-13 g, respectively; both P<0.001). Global median left ventricular CF with transseptal approach was not statistically different from retroaortic approach, but CF in the apicoinferior and apicoseptal regions was higher with transseptal approach (P<0.001). CONCLUSIONS: Ventricular mapping demonstrates important regional variations in CF, but in general, CF is higher endocardially than epicardially where poor catheter orientation is associated with higher CF. A transseptal approach may lead to improved contact particularly in the apicoseptal and inferior regions.
Jesel et al. (Fri,) conducted a observational in Ventricular tachycardia (n=21). Ventricular mapping using a contact force-sensing catheter vs. Endocardial versus epicardial mapping; Transseptal versus retroaortic approach was evaluated on Contact force (CF) and force vector orientation (VO) (p=<0.001). Ventricular mapping using a contact force-sensing catheter demonstrated higher median contact force in the left and right endocardium (15 g and 13 g) compared to the epicardium (8 g, P<0.001).