{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:26:59Z","timestamp":1787063219980,"version":"build-2736575974"},"reference-count":60,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T00:00:00Z","timestamp":1730246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UCLH Biomedicine NIHR"},{"name":"Barts BRC"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Alterations in repolarization gradients and increased heterogeneity are key electrophysiological determinants of ventricular arrhythmogenesis across a variety of aetiologies with and without structural heart disease. High-density repolarization mapping to localize these repolarization abnormalities could improve characterization of the individual arrhythmogenic substrate and inform more targeted ablation. Yet, due to challenges posed by intrinsic features of human cardiac repolarization itself as well as technical and practical limitations, they are not routinely assessed, and traditional substrate mapping techniques remain strictly limited to determining conduction abnormalities. Here, we provide an overview of the mechanistic role of repolarization alterations in ventricular re-entry arrhythmias followed by a description of a clinical workflow that enables high-density repolarization mapping during ventricular tachycardia (VT) ablations using existing clinical tools. We describe step-by-step guidance of how-to set-up and generate repolarization maps illustrating the approach in case examples of structural normal and abnormal hearts. Furthermore, we discuss how repolarization mapping could be combined with existing substrate mapping approaches, including isochronal late activation mapping, to delineate sites of increased re-entry vulnerability, that may represent targets for ablation without the requirement for VT induction. Finally, we review challenges and pitfalls and ongoing controversies in relation to repolarization mapping and discuss the need for future technical and analytical improvements in repolarization mapping to integrate into ventricular substrate mapping strategies. Repolarization mapping remains investigational, and future research efforts need to be focused on prospective trials to establish the additional diagnostic value and its role in clinical ablation procedures.<\/jats:p>","DOI":"10.1093\/europace\/euae271","type":"journal-article","created":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T16:13:44Z","timestamp":1730132024000},"source":"Crossref","is-referenced-by-count":9,"title":["High-density isochronal repolarization mapping and re-entry vulnerability estimation for scar-related ventricular tachycardia ablation: mechanistic basis, clinical application, and challenges"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4689-8384","authenticated-orcid":false,"given":"Johanna B","family":"Tonko","sequence":"first","affiliation":[{"name":"Institute for Cardiovascular Science, University College London , 5 University Street, London WC1E 6JF ,","place":["UK"]},{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital , W Smithfield, London EC1A 7BE ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6111-0022","authenticated-orcid":false,"given":"Anthony","family":"Chow","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital , W Smithfield, London EC1A 7BE ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9055-9267","authenticated-orcid":false,"given":"Pier D","family":"Lambiase","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Science, University College London , 5 University Street, London WC1E 6JF ,","place":["UK"]},{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital , W Smithfield, London EC1A 7BE ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,10,31]]},"reference":[{"key":"2024112718175877500_euae271-B1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/europace\/euad225","article-title":"Twenty-five years of catheter ablation of ventricular tachycardia: a look back and a look forward","volume":"25","author":"Natale","year":"2023","journal-title":"Europace"},{"key":"2024112718175877500_euae271-B2","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/j.jacep.2022.03.002","article-title":"Repolarization heterogeneity in human post-infarct ventricular tachycardia","volume":"8","author":"Callens","year":"2022","journal-title":"JACC Clin Electrophysiol"},{"key":"2024112718175877500_euae271-B3","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1038\/s41467-022-28418-1","article-title":"Heterogeneous repolarization creates tachycardia circuits in healed myocardial infarction scar","volume":"13","author":"Kelemen","year":"2022","journal-title":"Nature Comm"},{"key":"2024112718175877500_euae271-B4","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.hrthm.2020.09.020","article-title":"Critical repolarization gradients determine the induction of reentry-based torsades de pointes arrhythmia in models of long QT syndrome","volume":"18","author":"Rivaud","year":"2021","journal-title":"Heart Rhythm"},{"key":"2024112718175877500_euae271-B5","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/j.hrthm.2008.02.028","article-title":"Repolarisation heterogeneity in the right ventricular outflow tract: correlation with ventricular arrhythmias in Brugada patients and in an in vitro canine Brugada model","volume":"5","author":"Morita","year":"2008","journal-title":"Heart Rhythm"},{"key":"2024112718175877500_euae271-B6","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/j.jacep.2018.04.007","article-title":"Infarct related ventricular tachycardia: redefining the electrophysiological substrate of the isthmus during sinus rhythm","volume":"4","author":"Anter","year":"2018","journal-title":"JACC Clin Electrophysiol"},{"key":"2024112718175877500_euae271-B7","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.hrthm.2009.01.013","article-title":"Dispersion of repolarization and arrhythmogenesis","volume":"6","author":"Coronel","year":"2009","journal-title":"Heart Rhythm"},{"key":"2024112718175877500_euae271-B8","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.1016\/j.hrthm.2015.04.013","article-title":"An activation-repolarization time metric to predict localized regions of high susceptibility to reentry","volume":"12","author":"Child","year":"2015","journal-title":"Heart Rhythm"},{"key":"2024112718175877500_euae271-B9","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1161\/CIRCEP.108.825356","article-title":"Is there a significant transmural gradient in repolarization time in the intact heart? 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