Key result
Residual high-frequency electrogram burden ≥70% post-ablation is linked to ~13-fold higher VT recurrence or storm risk.
Why the study?
Peak frequency analysis has emerged as a novel tool to assess electrogram properties, and this study aimed to evaluate it as an objective method to confirm lesion efficacy during VT ablation.
Does achieving <70% residual high frequency electrogram burden during VT ablation reduce VT recurrence or arrhythmic storm in patients undergoing VT ablation?
Cohort (n=43)
Does achieving <70% residual high frequency electrogram burden during VT ablation reduce VT recurrence or arrhythmic storm in patients undergoing VT ablation?
Achieving a low residual high-frequency electrogram burden (<70%) post-ablation is strongly associated with improved VT-free survival, suggesting peak frequency analysis is a valuable tool for confirming lesion efficacy.
Background Peak frequency (PF) analysis has recently emerged as a novel tool to assess electrogram properties through their frequency spectrum. PF is an indirect marker of local myocardial activity, and its reduction after radiofrequency ablation reflects effective tissue modification. Purpose Our study aims to evaluate PF analysis as an objective method to confirm lesion efficacy during ventricular tachycardia (VT) ablation. Methods We retrospectively analysed 43 (out of 247) consecutive patients who underwent VT ablation between January 2023 and December 2024, using a multipolar high-density grid-shaped catheter. Complete pre- and post-ablation high-density sinus rhythm maps were obtained. PF analysis was applied offline to quantify the residual high frequency (HF) electrogram burden, expressed as a percentage of the ablated area. Patients were stratified according to residual HF burden, and outcomes were assessed with Kaplan-Meier survival analysis and Cox regression analysis. Results During a median follow-up of 372 days, eleven patients reached the primary endpoint (VT recurrence or arrhythmic storm). Patients with <70% residual HF post-ablation had significantly higher VT-free survival (≈90% at 12 months) compared to those with ≥70% residual HF (≈25%; log-rank p<0.001). Cox regression confirmed residual HF ≥70% as an independent predictor of recurrence (HR 13.36; 95% CI 3.52–50.7; p<0.001). Conclusion PF analysis during remapping provides an operator-independent, reproducible tool to confirm lesion efficacy. A low post-ablation residual HF burden is associated to a significantly increased VAs-free survival rate.
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Valente et al. (2026) conducted a cohort in Ventricular tachycardia (n=43). Residual high frequency (HF) electrogram burden ≥70% vs. Residual HF burden <70% was evaluated on Ventricular tachycardia recurrence or arrhythmic storm (HR 13.36, 95% CI 3.52-50.7, p=<0.001). Residual high frequency electrogram burden ≥70% post-ablation was an independent predictor of ventricular tachycardia recurrence or arrhythmic storm (HR 13.36; 95% CI 3.52-50.7; p<0.001).
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