Left Ventricular wall Thickness and Decrement Evoked Potentials in Ablation of Ischemic Ventricular Tachycardia

Q: What are the key findings of this study?

CT-derived mean left ventricular wall thickness (OR 0.65, p<0.001) and its coefficient of variation (OR 1.10, p<0.001) were significantly associated with decrement evoked potentials during VT mapping.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Ischemic heart disease undergoing ventricular tachycardia (VT) ablation (n=14). Intervention: Left ventricular wall thickness (LVWT) mean and coefficient of variation measured by preprocedural cardiac computed tomography (CT). Primary outcome: Presence of decrement evoked potentials (DeEPs), defined as late potentials with a decremental delay response >20 ms after S2 extrastimulus delivery (at 50 ms above VERP), per left ventricular segment (n=224 segments) (OR 0.65, 95% CI 0.55-0.78, p=<0.001).

Q: What does this research mean for the field?

Cardiac CT-derived lower mean left ventricular wall thickness and higher wall thickness variation are significantly associated with the presence of arrhythmogenic decrement evoked potentials in patients with ischemic ventricular tachycardia. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine whether an association exists between left ventricular wall thickness derived from preprocedural cardiac CT and decrement evoked potentials identified during electroanatomic mapping.

Alwin B. P. Noordman; Ahmed Yassin; Michiel Rienstra; Alexander H. Maass; Yuri Blaauw

doi:10.1111/pace.70240

April 2, 2026Pacing and Clinical Electrophysiology

Left Ventricular wall Thickness and Decrement Evoked Potentials in Ablation of Ischemic Ventricular Tachycardia

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Key result

Greater CT-derived LV wall thickness is linked to ~35% lower odds of decrement evoked potentials.

OR 0.65
95% CI 0.55-0.78
P<0.001
n=14

Figures

Why the study?

Preprocedural imaging can improve VT ablation success and CT-derived left ventricular wall thickness can identify infarct regions, but its association with electroanatomic decrement evoked potentials was unknown.

Is left ventricular wall thickness (LVWT) measured by preprocedural cardiac computed tomography associated with the presence of decrement evoked potentials (DeEPs) on electroanatomic mapping in patients with ischemic heart disease undergoing ventricular tachycardia ablation?

Key Points

To determine whether an association exists between left ventricular wall thickness derived from preprocedural cardiac CT and decrement evoked potentials identified during electroanatomic mapping.
Retrospective single-center analysis of 14 patients (mean age 69 ± 7 years; 92.9% male) with ischemic heart disease who underwent endocardial ventricular tachycardia ablation between January 2021 and March 2023 at UMCG.
Preprocedural CT scans and electroanatomic maps were merged into a 3D left ventricular model segmented into 17 standard segments, analyzing 224 total segments.
The primary endpoint was segment presence of decrement evoked potentials (DeEPs; late potentials with decremental delay > 20 ms after an S2 extrastimulus), evaluated against mean segment LVWT and coefficient of variation of LVWT.
DeEPs were present in 63 of 224 left ventricular segments, with DeEP-positive segments demonstrating a significantly lower mean LVWT (7.2 ± 2.3 mm vs 8.5 ± 1.9 mm; p < 0.001) and higher median coefficient of variation (0.229 vs 0.169; p < 0.001) than DeEP-negative segments.
Mixed effects multilevel logistic regression demonstrated that mean LVWT was significantly associated with DeEP presence (OR 0.65, 95% CI 0.55–0.78; p < 0.001; AUC 0.670), as was the coefficient of variation of LVWT (OR 1.10, 95% CI 1.06–1.15; p < 0.001; AUC 0.661).

Study Design

Type

Observational (n=14)

Blinding

CT images and electroanatomic maps were processed by independent observers blinded to the other's work

Multicenter

No

Structured PICO

Is left ventricular wall thickness (LVWT) measured by preprocedural cardiac computed tomography associated with the presence of decrement evoked potentials (DeEPs) on electroanatomic mapping in patients with ischemic heart disease undergoing ventricular tachycardia ablation?

P

Population

14 adults (mean age 69 years, 7.1% female) with ischemic heart disease and recurrent ventricular arrhythmias undergoing endocardial VT ablation with preprocedural cardiac CT and EnSite X electroanatomic mapping at a single center in the Netherlands.

E

Exposure

Preprocedural cardiac computed tomography (CT) imaging processed with ADAS 3D software to measure segment-level left ventricular wall thickness (LVWT) and coefficient of variation of LVWT, merged with 3D electroanatomic mapping (EAM) obtained during endocardial VT ablation.

O

Outcome

Presence of decrement evoked potentials (DeEPs)—defined as near-field, distinctive, late potentials exhibiting a decremental delay response >20 ms after S2 extrastimulus delivery (at 50 ms above the ventricular effective refractory period)—in each of the 17 left ventricular segments (excluding the apex).surrogate

Main Result

Odds Ratio: 0.65 (95% CI 0.55–0.78)

p-value: p=<0.001

Preprocedural CT-derived left ventricular wall thickness and its regional variation are significantly associated with the presence of decrement evoked potentials (DeEPs), suggesting CT imaging can aid in non-invasively identifying arrhythmogenic targets prior to ischemic VT ablation.

Limitations

Modest sample size (n=14 patients)
Precision of myocardial characterization limited by the size of the 17-segment model
Clinical outcomes of the ablation procedure were not obtained
Potential imperfect spatial alignment when merging CT and electroanatomic mapping 3D models
Classification of DeEP-positive segments is susceptible to variability in HD grid orientation and local mapping density
Limited applicability to apical VTs as the apex segment was excluded due to natural thinning
VT mapping was only available in half of the patients, precluding systematic analysis of the spatial relationship with the VT isthmus
Modest sample size (n=14)
Precision of myocardial characterization was limited by the size of LV segments
Imperfect alignment when merging CT and EAM 3D models due to different acquisition times and catheter positioning difficulties
Susceptibility of DeEP classification to variability in HD grid orientation and local mapping density
Limited applicability to VTs originating from the apex due to exclusion of the apical segment
VT mapping was only available in half of the patients, precluding systematic analysis of the spatial relationship between VT isthmus, DeEP-positive regions, and reduced wall thickness

Discussion

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Implication

CT wall thickness metrics may aid DeEP localization; leaves open whether preprocedural CT improves ischemic VT ablation outcomes.

Abstract

Introduction Preprocedural imaging can improve the success rate of ventricular tachycardia (VT) ablation. Left ventricular wall thickness (LVWT) measured by cardiac computed tomography (CT) can be used to identify infarct regions. We sought to determine whether an association exists between left ventricular wall thickness (LVWT) as obtained from CT imaging and the presence of decrement evoked potentials (DeEPs) as obtained from electroanatomic mapping. Methods In this single‐center, retrospective analysis, 14 patients with ischemic heart disease who underwent a VT ablation in the University Medical Center Groningen (UMCG) between January 2021 and March 2023 were included. CT images as well as electroanatomic maps were obtained and processed, after which a 3D model of the left ventricle was obtained and segmented in 17 segments. The primary outcome was the presence of DeEPs, defined as late potentials exhibiting a decremental delay response longer than 20 ms after S2 extrastimulus delivery (with the extrastimulus delivered at 50 ms above the ventricular effective refractory period [VERP]), in each of the left ventricular segments. The mean segment LVWT and coefficient of variation of LVWT, defined as the standard deviation of the LVWT of each segment divided by the mean segment LVWT, were analyzed as determinants of the primary outcome. Results The mean age was 69 ± seven years and 13 (92.9%) patients were male. The mean LVWT was significantly associated with the presence of DeEPs in left ventricular segments [odds ratio (OR) 0.65 (95% confidence interval (CI) 0.55 – 0.78); p < 0.001], as was the coefficient of variation of LVWT [OR 1.10 (95% CI 1.06 – 1.15); p < 0.001]. Conclusions The mean and coefficient of variation of LVWT were significantly associated with the presence of DeEPs. This may possibly allow for the preprocedural identification of arrhythmogenic regions as potential targets for VT ablation.

Cite This Study

Noordman et al. (2026) conducted an observational in Ischemic heart disease undergoing ventricular tachycardia (VT) ablation (n=14). Left ventricular wall thickness (LVWT) mean and coefficient of variation measured by preprocedural cardiac computed tomography (CT) was evaluated on Presence of decrement evoked potentials (DeEPs), defined as late potentials with a decremental delay response >20 ms after S2 extrastimulus delivery (at 50 ms above VERP), per left ventricular segment (n=224 segments) (OR 0.65, 95% CI 0.55-0.78, p=<0.001). CT-derived mean left ventricular wall thickness (OR 0.65, p<0.001) and its coefficient of variation (OR 1.10, p<0.001) were significantly associated with decrement evoked potentials during VT mapping.

synapsesocial.com/papers/69cf5cd15a333a821460a685 https://doi.org/10.1111/pace.70240

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Left Ventricular wall Thickness and Decrement Evoked Potentials in Ablation of Ischemic Ventricular Tachycardia

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Abstract

Cite This Study

Left Ventricular wall Thickness and Decrement Evoked Potentials in Ablation of Ischemic Ventricular Tachycardia

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Abstract

Cite This Study

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