Key result
Residual high-frequency electrogram burden ≥70% post-ablation linked to ~13.4-fold higher VT recurrence.
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Why the study?
Peak frequency analysis has recently emerged as a novel tool to assess electrogram properties and validate lesion efficacy during ventricular tachycardia ablation.
Cohort (n=43)
Residual high-frequency electrogram burden ≥70% was associated with VT recurrence; hypothesis-generating for peak frequency analysis as ablation endpoint, needing prospective confirmation.
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. OBJECTIVE: our study aims to evaluate PF analysis as an objective method to validate lesion efficacy during ventricular tachycardia (VT) ablation. METHODS: we retrospectively analyzed 43 (out of 247) consecutive patients who underwent VT ablation between January 2023 and December 2024, using the EnSite X mapping system with Advisor HD Grid catheter (Abbott, Minneapolis, USA). 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, 11 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 re-mapping provides an operator-independent, reproducible tool to validate lesion efficacy. A low post-ablation residual HF burden is associated to a significantly increased VAs-free survival rate.
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Cauti et al. (2026) conducted a cohort in Ventricular tachycardia (VT) (n=43). Residual high-frequency electrogram burden ≥70% vs. Residual high-frequency electrogram burden <70% was evaluated on VT recurrence or arrhythmic storm (HR 13.36, 95% CI 3.52-50.7, p=<0.001). A residual high-frequency electrogram burden ≥70% post-ablation was an independent predictor of ventricular tachycardia recurrence (HR 13.36; 95% CI 3.52-50.7; p<0.001).
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