{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:16Z","timestamp":1787028616655,"version":"build-2736575974"},"reference-count":45,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,8,30]],"date-time":"2022-08-30T00:00:00Z","timestamp":1661817600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Emile Letang Grant of Hospital Clinic de Barcelona\/Instituto de Salud Carlos III (ISCIII)","award":["PI20\/00693\/CB16\/11\/00354"],"award-info":[{"award-number":["PI20\/00693\/CB16\/11\/00354"]}]},{"name":"European Union\/CIBERCV16-CB16\/11\/00354 of Instituto de Salud Carlos III, Madrid","award":["PI20\/00693\/CB16\/11\/00354"],"award-info":[{"award-number":["PI20\/00693\/CB16\/11\/00354"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Catheter ablation of ventricular tachycardia has demonstrated its important role in the treatment of ventricular tachycardia in patients with structural cardiomyopathy. Conventional mapping techniques used to define the critical isthmus, such as activation mapping and entrainment, are limited by the non-inducibility of the clinical tachycardia or its poor hemodynamic tolerance. To overcome these limitations, a voltage mapping strategy based on bipolar electrograms peak to peak analysis was developed, but a low specificity (30%) for VT isthmus has been described with this approach. Functional mapping strategy relies on the analysis of the characteristics of the electrograms but also their propagation patterns and their response to extra-stimulus or alternative pacing wavefronts to define the targets for ablation. With this review, we aim to summarize the different functional mapping strategies described to date to identify ventricular arrhythmic substrate in patients with structural heart disease.<\/jats:p>","DOI":"10.3390\/jcdd9090288","type":"journal-article","created":{"date-parts":[[2022,8,31]],"date-time":"2022-08-31T00:13:56Z","timestamp":1661904836000},"page":"288","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Ventricular Tachycardia Ablation Guided by Functional Substrate Mapping: Practices and Outcomes"],"prefix":"10.3390","volume":"9","author":[{"given":"Sara","family":"V\u00e1zquez-Calvo","sequence":"first","affiliation":[{"name":"Arrhythmia Unit, Cardiology Deparment of the Institut Cl\u00ednic Cardiovascular (ICCV) at Hospital Cl\u00ednic de Barcelona, Universitat de Barcelona and Institut d\u2019Investigacions Biom\u00e9diques August Pi i Sunyer (IDIBAPS), C\/Villarroel No 170, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivo","family":"Roca-Luque","sequence":"additional","affiliation":[{"name":"Arrhythmia Unit, Cardiology Deparment of the Institut Cl\u00ednic Cardiovascular (ICCV) at Hospital Cl\u00ednic de Barcelona, Universitat de Barcelona and Institut d\u2019Investigacions Biom\u00e9diques August Pi i Sunyer (IDIBAPS), C\/Villarroel No 170, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3510-1488","authenticated-orcid":false,"given":"Andreu","family":"Porta-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Arrhythmia Unit, Cardiology Deparment of the Institut Cl\u00ednic Cardiovascular (ICCV) at Hospital Cl\u00ednic de Barcelona, Universitat de Barcelona and Institut d\u2019Investigacions Biom\u00e9diques August Pi i Sunyer (IDIBAPS), C\/Villarroel No 170, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/0735-1097(88)90370-1","article-title":"Prognosis of patients with ventricular tachycardia and ventricular fibrillation: Role of the underlying etiology","volume":"12","author":"Trappe","year":"1988","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1016\/j.hrthm.2011.07.036","article-title":"Shocks burden and increased mortality in implantable cardioverter-defibrillator patients","volume":"8","author":"Larsen","year":"2011","journal-title":"Heart Rhythm"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1007\/s10840-019-00535-w","article-title":"Pan-Asia United States PrEvention of Sudden Cardiac Death Catheter Ablation Trial (PAUSE-SCD): Rationale and study design","volume":"57","author":"Chen","year":"2019","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1161\/CIRCULATIONAHA.122.059598","article-title":"Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator? Results From the Multicenter Randomized PARTITA Trial","volume":"145","author":"Bella","year":"2022","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1016\/j.jacc.2022.01.050","article-title":"Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia","volume":"79","author":"Arenal","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2872","DOI":"10.1016\/j.jacc.2015.10.026","article-title":"Ablation of Stable VTs Versus Substrate Ablation in Ischemic Cardiomyopathy","volume":"66","author":"Biase","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1161\/CIRCEP.114.002386","article-title":"Scar dechanneling","volume":"8","author":"Berruezo","year":"2015","journal-title":"Circ. Arrhythmia Elec."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1161\/01.CIR.0000083725.72693.EA","article-title":"Characterization of Endocardial Electrophysiological Substrate in Patients With Nonischemic Cardiomyopathy and Monomorphic Ventricular Tachycardia","volume":"108","author":"Hsia","year":"2003","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1161\/01.CIR.101.11.1288","article-title":"Linear Ablation Lesions for Control of Unmappable Ventricular Tachycardia in Patients with Ischemic and Nonischemic Cardiomyopathy","volume":"101","author":"Marchlinski","year":"2000","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Roca-Luque, I., Zaraket, F., Garre, P., Sanchez-Somonte, P., Quinto, L., Borras, R., Guasch, E., Arbelo, E., Tolosana, J.M., and Brugada, J. (2022). Accuracy of standard bipolar amplitude voltage thresholds to identify late potential channels in ventricular tachycardia ablation. J. Interv. Card. Electrophysiol., 1\u201311.","DOI":"10.1007\/s10840-022-01148-6"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1016\/S0735-1097(97)00257-X","article-title":"Catheter Ablation of Ventricular Tachycardia After Myocardial Infarction: Relation of Endocardial Sinus Rhythm Late Potentials to the Reentry Circuit","volume":"30","author":"Harada","year":"1997","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2184","DOI":"10.1161\/CIRCULATIONAHA.111.043216","article-title":"Elimination of Local Abnormal Ventricular Activities","volume":"125","author":"Maury","year":"2012","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.amjcard.2022.02.053","article-title":"Late Potential Abolition in Ventricular Tachycardia Ablation","volume":"174","author":"Quinto","year":"2022","journal-title":"Am. J. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/j.hrthm.2021.02.016","article-title":"Ventricular tachycardia burden reduction after substrate ablation: Predictors of recurrence","volume":"18","author":"Quinto","year":"2021","journal-title":"Heart Rhythm"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/j.hrthm.2015.09.033","article-title":"Bipolar voltage amplitude: What does it really mean?","volume":"13","author":"Anter","year":"2016","journal-title":"Heart Rhythm"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1853","DOI":"10.1016\/j.hrthm.2018.07.020","article-title":"Effect of bipolar electrode orientation on local electrogram properties","volume":"15","author":"Takigawa","year":"2018","journal-title":"Heart Rhythm"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1007\/s10840-020-00918-4","article-title":"Impact of a high-density grid catheter on long-term outcomes for structural heart disease ventricular tachycardia ablation","volume":"62","author":"Proietti","year":"2021","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e003841","DOI":"10.1161\/CIRCEP.115.003841","article-title":"High-Resolution Mapping of Ventricular Scar","volume":"9","author":"Tschabrunn","year":"2016","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"912335","DOI":"10.3389\/fcvm.2022.912335","article-title":"Orthogonal high density mapping with VT isthmus analysis vs. pure substrate VT ablation: A case-control study","volume":"9","author":"Garre","year":"2022","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2088","DOI":"10.1016\/j.jacc.2013.02.031","article-title":"Relationship Between Voltage Map \u201cChannels\u201d and the Location of Critical Isthmus Sites in Patients with Post-Infarction Cardiomyopathy and Ventricular Tachycardia","volume":"61","author":"Mountantonakis","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1997","DOI":"10.1016\/j.hrthm.2015.05.036","article-title":"Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: An International VT Ablation Center Collaborative Group study","volume":"12","author":"Tung","year":"2015","journal-title":"Heart Rhythm"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1161\/CIRCEP.113.001404","article-title":"Noninducibility in Postinfarction Ventricular Tachycardia as an End Point for Ventricular Tachycardia Ablation and Its Effects on Outcomes","volume":"7","author":"Ghanbari","year":"2014","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"H47","DOI":"10.1152\/ajpheart.1992.262.1.H47","article-title":"Vulnerability of rabbit atrium to reentry by hypoxia. Role of inhomogeneity in conduction and wavelength","volume":"262","author":"Lammers","year":"1992","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.hrthm.2009.09.025","article-title":"Mechanisms that initiate ventricular tachycardia in the infarcted human heart","volume":"7","author":"Segal","year":"2010","journal-title":"Heart Rhythm"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1161\/CIRCEP.115.003083","article-title":"Decrement Evoked Potential Mapping: Basis of a Mechanistic Strategy for Ventricular Tachycardia Ablation","volume":"8","author":"Jackson","year":"2015","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"H1573","DOI":"10.1152\/ajpheart.00794.2003","article-title":"A model for human ventricular tissue","volume":"286","author":"Tusscher","year":"2004","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.jacep.2017.12.005","article-title":"Multicenter Study of Ischemic Ventricular Tachycardia Ablation with Decrement-Evoked Potential (DEEP) Mapping with Extra Stimulus","volume":"4","author":"Jackson","year":"2018","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1093\/europace\/euw325","article-title":"Elucidation of hidden slow conduction by double ventricular extrastimuli: A method for further arrhythmic substrate identification in ventricular tachycardia ablation procedures","volume":"20","author":"Acosta","year":"2016","journal-title":"Europace"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1696","DOI":"10.1016\/j.hrthm.2020.05.017","article-title":"Long-term outcomes of ventricular tachycardia substrate ablation incorporating hidden slow conduction analysis","volume":"17","author":"Acosta","year":"2020","journal-title":"Heart Rhythm"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.jacep.2018.01.013","article-title":"Targeting the Hidden Substrate Unmasked by Right Ventricular Extrastimulation Improves Ventricular Tachycardia Ablation Outcome After Myocardial Infarction","volume":"4","author":"Riva","year":"2018","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s12968-015-0133-1","article-title":"Distribution of abnormal potentials in chronic myocardial infarction using a real time magnetic resonance guided electrophysiology system","volume":"17","author":"Oduneye","year":"2015","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1093\/europace\/euy265","article-title":"Ventricular substrate identification using close-coupled paced electrogram feature analysis","volume":"21","author":"Shariat","year":"2018","journal-title":"Europace"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/0735-1097(94)90509-6","article-title":"Analysis of the initiation of spontaneous monomorphic ventricular tachycardia by stored intracardiac electrograms","volume":"23","author":"Roelke","year":"1994","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/S0002-9149(99)00815-2","article-title":"Analysis of intracardiac electrograms showing monomorphic ventricular tachycardia in patients with implantable cardioverter-defibrillators","volume":"85","author":"Saeed","year":"2000","journal-title":"Am. J. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1016\/j.jacep.2020.06.037","article-title":"Multicenter Study of Dynamic High-Density Functional Substrate Mapping Improves Identification of Substrate Targets for Ischemic Ventricular Tachycardia Ablation","volume":"6","author":"Srinivasan","year":"2020","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1161\/01.RES.82.2.279","article-title":"Characteristics of the Temporal and Spatial Excitable Gap in Anisotropic Reentrant Circuits Causing Sustained Ventricular Tachycardia","volume":"82","author":"Peters","year":"1998","journal-title":"Circ. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1016\/j.hrthm.2009.02.038","article-title":"Myofibroblasts in diseased hearts: New players in cardiac arrhythmias?","volume":"6","author":"Rohr","year":"2009","journal-title":"Heart Rhythm"},{"key":"ref_38","first-page":"539","article-title":"Ablation of Reentry-Vulnerable Zones Determined by Left Ventricular Activation from Multiple Directions: A Novel Approach for Ventricular Tachycardia Ablation: A Multicenter Study (PHYSIO-VT)","volume":"13","author":"Anter","year":"2020","journal-title":"Circ. Arrhythmia Electrophysiol. Lippincott Williams Wilkins"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1161\/CIRCEP.114.002637","article-title":"Relationship Between Sinus Rhythm Late Activation Zones and Critical Sites for Scar-Related Ventricular Tachycardia","volume":"8","author":"Irie","year":"2015","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1161\/CIRCULATIONAHA.119.042423","article-title":"Targeted Ablation of Ventricular Tachycardia Guided by Wavefront Discontinuities during Sinus Rhythm: A New Functional Substrate Mapping Strategy","volume":"140","author":"Aziz","year":"2019","journal-title":"Circulation"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.amjcard.2012.10.031","article-title":"Safety, Long-Term Results, and Predictors of Recurrence After Complete Endocardial Ventricular Tachycardia Substrate Ablation in Patients With Previous Myocardial Infarction","volume":"111","author":"Arenal","year":"2013","journal-title":"Am. J. Cardiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.jacc.2012.03.044","article-title":"Endo-epicardial homogenization of the scar versus limited substrate ablation for the treatment of electrical storms in patients with ischemic cardiomyopathy","volume":"60","author":"Biase","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1161\/CIRCEP.113.000073","article-title":"Characteristics of Intramural Scar in Patients with Nonischemic Cardiomyopathy and Relation to Intramural Ventricular Arrhythmias","volume":"6","author":"Desjardins","year":"2013","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e007500","DOI":"10.1161\/CIRCEP.119.007500","article-title":"Grid Mapping Catheter for Ventricular Tachycardia Ablation","volume":"12","author":"Okubo","year":"2019","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1093\/europace\/euw406","article-title":"Multielectrode vs. point-by-point mapping for ventricular tachycardia substrate ablation: A randomized study","volume":"20","author":"Acosta","year":"2017","journal-title":"Europace"}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/9\/9\/288\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:20:01Z","timestamp":1760142001000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/9\/9\/288"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,30]]},"references-count":45,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["jcdd9090288"],"URL":"https:\/\/doi.org\/10.3390\/jcdd9090288","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,30]]}}}