Multielectrode contact mapping to assess scar modification in post-myocardial infarction ventricular tachycardia patients

Substrate-based approaches for ablation of unmappable ventricular tachycardia (VT) are strictly dependent on high-density mapping of the scar. Ultra-high-density mapping with multielectrode catheters facilitates an accurate and faster definition of sites critical for re-entry, due to the possibility of simultaneous recordings of local potential from different pairs of electrodes. Multipolar catheters can be advanced to map the endocardial or the epicardial surface. A strong correlation between the scar area determined by electroanatomical mapping and the histopathological scar size has been demonstrated. A double-transeptal technique allows for an accurate definition of target sites. The complex scar architecture has been investigated by ultra-high-density mapping, let the identification of islets of heterogeneity where electrograms adjacent to the preserved myocardium have an higher incidence of late potentials. Pacing manoeuvres can easily be performed from any pair of electrode, to demonstrate the involvement of late potentials into the VT circuit. This strategy allows for a clear-cut validation of late potential abolishment, and may offer advantages to shorten procedural and fluoroscopy times. Large series are necessary to definitively assess the potential role of multielectrode mapping as a guide for the substrate ablation approach in post-myocardial infarction VT patients.