Background: In patients with scar-related left ventricular tachycardia (LV-VT), identifying the relevant substrate is crucial.Objective: To evaluate the role of post-pacing interval (PPI)tachycardia cycle length (TCL) interval after a failed antitachycardia pacing (ATP) from implantable cardioverterdefibrillator (ICD) in predicting the LV-VT substrate.Methods: Patients with failed ATPs undergoing ablation of scarrelated LV-VT were retrospectively analyzed.Electrograms (EGMs) of ICD interrogation showing failed ATPs with evidence of capture and stable TCL before and after the ATP were eligible for analysis.The VT substrate was established during catheter ablation.Endocardial VT was determined as scar-related VT with the entire circuit mapped from the endocardium, and the VT was terminated only by endocardial ablation.Intramural VT was determined as scar-related VT with no diastolic component mapped in the endocardium and requiring bipolar/sequential unipolar ablation and/or alcohol septal ablation.Results: 61 LV-VTs were analyzed (male: 52, ischemic: 32).All patients had ICD leads at RV apical septum.A median of 3.0 failed ATP EGMs were analyzed, and the PPI-TCL was averaged for each VT.
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Sugawara et al. (2024) studied this question.
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