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August 28, 2026Journal of the American College of CardiologyOpen Access

The Value of Defibrillator Electrograms for Recognition of Clinical Ventricular Tachycardias and for Pace Mapping of Post-Infarction Ventricular Tachycardia

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Key result

Stored ICD electrograms distinguish clinical VTs from ~98% of other inducible VTs, matching 12-lead ECGs.

  • n=21

Why the study?

Twelve-lead ECGs of spontaneous VT are often unavailable prior to ablation, and the ability of ICD EGMs to identify specific VT configurations was undescribed.

Can stored ICD EGMs accurately identify clinical VTs and provide useful pace mapping resolution in patients undergoing catheter ablation for post-infarction VT?

Population

21 consecutive patients referred for catheter ablation of post-infarction VT

Comparison

ICD electrograms vs 12-lead ECGs

Design

Observational study

Authors

KYKentaro YoshidaJikei University School of MedicineTLTzu-Yu LiuUniversity of MichiganCSClayton ScottUniversity of Michigan

Discussion

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Member takes

Key expert perspectives

Captured external expert commentary on this paper, strongest first. Original sources are linked where available.

BPBinu PhilipsElectrophysiologist, Johns Hopkins University

“Yoshida et al. recently showed that stored ICD-EGMs can (a) serve as an accurate surrogate for 12-lead ECGs for differentiating clinical VTs from other VTs, and (b) serve as a template for pace-mapping of VT exit sites. Our case highlights the importance and applicability of Yoshida and colleagues' findings to the case of idiopathic VF.”

Johns Hopkins UniversityNews Coverage
AEAnonymous editorial authorJournal of Interventional Cardiac Electrophysiology

“Yoshida et al. first demonstrated that ICD EGMs can approximate the morphology of clinical ventricular tachycardia (VT) and guide pacemapping with acceptable spatial accuracy. Subsequent work extended this principle to ablation of non-inducible VT and VF.”

Journal of Interventional Cardiac ElectrophysiologyEditorial

Implication

May aid clinical VT targeting in post-MI ablation; hypothesis-generating observational data requiring prospective validation.

Key Points

  • To determine the accuracy of stored implantable cardioverter-defibrillator (ICD) electrograms (EGMs) in identifying clinical ventricular tachycardias (VTs) and assessing spatial resolution during pace mapping.
  • Studied 21 consecutive patients referred for catheter ablation of post-infarction VT, inducing 124 VTs (mean cycle length: 393 ± 103 ms) with concurrent ICD EGM recordings.
  • Compared 12-lead ECGs of clinical VTs (documented in 15 of 21 patients) against 64 inducible VTs using ROC curve cutoff analysis and visual inspection.
  • Calculated the spatial resolution of pace mapping to identify VT exit sites across 62 VTs for both 12-lead ECGs and ICD EGMs using custom software.
  • Stored ICD EGMs differentiated clinical VTs from 98% of other inducible VTs by ROC curve cutoff values and from 96% by visual inspection.
  • The mean spatial resolution for identifying the VT exit site was 2.9 ± 4.0 cm² (range: 0 to 17.5 cm²) for 12-lead ECG pace maps versus 8.9 ± 9.0 cm² (range: 0 to 35 cm²) for ICD EGM pace maps.
  • Spatial resolution for ICD EGMs was < 1.0 cm² for at least one target VT in 12 of 21 patients and in 19 of 62 total VTs.

Study Design

Type

Observational (n=21)

Structured PICO

Can stored ICD EGMs accurately identify clinical VTs and provide useful pace mapping resolution in patients undergoing catheter ablation for post-infarction VT?

P
Population
21 consecutive patients referred for catheter ablation of post-infarction ventricular tachycardia.
E
Exposure
Analysis of stored implantable cardioverter-defibrillator (ICD) electrograms (EGMs) for identifying clinical VTs and for pace mapping.
C
Comparator
12-lead ECGs (for comparison of pace mapping spatial resolution).
O
Outcome
Accuracy of ICD EGMs in differentiating clinical VTs from other induced VTs, and spatial resolution of pace mapping.surrogate

Stored ICD EGMs serve as an accurate surrogate for 12-lead ECGs in differentiating clinical VTs from other VTs and offer variable but potentially useful resolution for pace mapping during post-infarction VT ablation.

Cite This Study

Yoshida et al. (2010) conducted an observational in post-infarction ventricular tachycardia (n=21). Implantable cardioverter-defibrillator (ICD) electrograms vs. 12-lead electrocardiograms was evaluated on differentiation of clinical VTs from other inducible VTs. Stored ICD electrograms accurately distinguished clinical ventricular tachycardias from 98% of other inducible VTs, serving as an accurate surrogate for 12-lead ECGs.

synapsesocial.com/papers/6a91a6da655daed6ced44848https://doi.org/10.1016/j.jacc.2010.04.043
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Characteristics of ventricular intracardiac electrograms of ventricular tachycardias originating from the epicardia in patients with an implantable cardioverter defibrillator2019 · 2 citations
  2. 2Implantable Defibrillator Electrograms and Origin of Left Ventricular Impulses: An Analysis of Regionalization Ability and Visual Spatial Resolution2011 · 14 citations
  3. 3Inadequacy of Qualitative Implantable Cardioverter Defibrillator Electrogram Analysis to Distinguish Supraventricular from Ventricular Tachycardia Due to Electrogram Changes During Normally Conducted Complexes1997 · 6 citations
  4. 4The Use of Signal Analyses of Ventricular Tachycardia Electrograms to Predict the Response of Antitachycardia Pacing in Patients with Implantable Cardioverter‐Defibrillators2013 · 9 citations
  5. 5An efficient algorithm based on electrograms characteristics to identify ventricular tachycardia isthmus entrance in post-infarct patients2019 · 11 citations