Relevance of systematic multipolar remapping after ventricular tachycardia substrate ablation

Abstract Aims Substrate ablation has emerged as a safe and effective strategy for patients with ventricular tachycardia (VT) and structural heart disease. The value of systematic multipolar remapping after ablation to confirm substrate elimination remains uncertain. We investigated whether omitting this step impacts long-term outcomes. Methods and results We included 102 consecutive patients with structural heart disease undergoing substrate-based VT ablation using the scar dechanneling technique in sinus or stable rhythm. After ablation, validation of substrate elimination was verified in all cases with the ablation catheter; in 44 patients (43.1%) an additional multipolar remapping was undertaken. Baseline clinical and procedural characteristics are summarized in table 1. The remap group more frequently had an ischemic etiology, with longer procedures and greater total radiofrequency delivery. Acute procedural outcome—defined as non-inducibility of any sustained monomorphic VT at the end of the procedure—was similar between groups (76% vs 68%; p=0.389). After a mean follow-up of 4 ± 3 years, VT recurrence occurred in 29.3% of the no-remap group and 15.9% of the remap group. Seven patients required a repeat ablation. Kaplan–Meier analysis showed lower VT recurrence in the remap group (figure 1). Multivariate analysis identified remap as the only independent predictor of VT recurrence, with a significantly lower associated risk (HR 0.38, 95% CI 0.16–0.89; p = 0.026). Thirty-day mortality (2.9% vs. 0%) and periprocedural complication rates (none in either group) were comparable. Conclusions Systematic multipolar remapping during substrate-based VT ablation was associated with a lower VT recurrence, suggesting a potential benefit for long-term arrhythmic outcomes.Table 1.Baseline and procedural charactFigure 1.Kaplan–Meier analysis of VT-fr