Key result
HD Grid mapping is linked to ~53 percentage points higher P1 detection in LPF-VT ablation.
Why the study?
Accurate identification of antegrade and retrograde pathways (P1-P2) is critical for successful radiofrequency ablation in patients with left posterior fascicular ventricular tachycardia, but the impact of HD Grid-guided mapping on detection and outcomes was unclear.
Does the addition of a high-density electroanatomic mapping catheter to standard radiofrequency ablation improve P1 potential detection, acute procedural success, and prevent arrhythmic recurrence in patients with left posterior fascicular ventricular tachycardia?
Cohort (n=25)
Does the addition of a high-density electroanatomic mapping catheter to standard radiofrequency ablation improve P1 potential detection, acute procedural success, and prevent arrhythmic recurrence in patients with left posterior fascicular ventricular tachycardia?
Absolute Event Rate: 92% vs 39%
p-value: p=0.008
The use of high-density electroanatomic mapping in left posterior fascicular VT ablation improves the identification of critical pathway potentials, translating into higher procedural success and lower arrhythmic recurrence.
BACKGROUND: In patients with left posterior fascicular ventricular tachycardia (LPF-VT), the most critical determinant of successful radiofrequency ablation (RFA) is the accurate identification of the antegrade and retrograde pathways (P1-P2) within the reentrant circuit. The aim of this study was to evaluate the impact of HD Grid-guided RFA on P1 potential detection, procedural duration, acute procedural success, and arrhythmic recurrence in patients with LPF-VT. METHODS: In this retrospective-cohort study, 25-patients with inducible tachycardia during electrophysiological study and a confirmed diagnosis of LPF-VT were included. Patients were divided into two-groups according to the use of the HD Grid Mapping Catheter during RFA: standard RFA group (Group-I) and standard RFA + HD Grid group (Group-II). Patients were followed for a mean duration of 24.8 ± 14.8 months after RFA. RESULTS: In Group-II, the frequency of P1 recording during VT and, consequently, P1-targeted RF applications was significantly higher than in Group-I (92% vs 39%, and, p = 0.008). Acute procedural success was achieved in all 12-patients (100%) in Group-II and in 9-patients (69%) in Group-I (p < 0.047). During follow-up, LPF-VT recurrence occurred in 7-patients (54%) in Group-I and 1-patient (8%) in Group-II (p < 0.020). CONCLUSION: In this study, the use of the HD Grid Mapping Catheter during RFA for LPF-VT was associated with a higher detection rate of P1 potentials compared with the standard RFA approach. Given the critical role of P1 potentials in determining procedural success, this finding may suggest a potential relationship with shorter procedural and fluoroscopy times, higher acute procedural success rates, and lower LPF-VT recurrence rates in this patient population.
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Koca et al. (2026) conducted a cohort in left posterior fascicular ventricular tachycardia (LPF-VT) (n=25). Standard RFA + HD Grid Mapping Catheter vs. Standard RFA was evaluated on P1 potential detection during VT (p=0.008). The use of an HD Grid mapping catheter during RFA for LPF-VT was associated with significantly higher P1 potential detection (92% vs 39%, p=0.008) and acute procedural success (100% vs 69%).
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