Extrastimuli-assisted functional mapping improves ventricular tachycardia ablation outcomes: A systematic review, meta-analysis, and meta-regression.

Abstract

<h4>Background</h4>In the context of ventricular tachycardia (VT) ablation, functional electroanatomic mapping techniques may help identify arrhythmogenic substrates in scarred and normal voltage areas. In addition, extrastimuli-assisted (dynamic) mapping may be more effective than intrinsic rhythm (static) approaches to uncover key ablation targets, potentially improving procedure outcomes.<h4>Objective</h4>We aimed to assess the efficacy and safety of functional mapping-assisted VT ablation and to compare procedural outcomes between dynamic and static mapping approaches.<h4>Methods</h4>PubMed/MEDLINE, Scopus, Web of Science, and Cochrane databases were searched using MeSH terms ventricular tachycardia ablation, functional mapping, recurrence, complications, and similar keywords. Meta-analyses of single proportions, rates, and means were performed, employing random effects models and P < .05. Subgroup analysis and meta-regression were performed.<h4>Results</h4>We included 16 studies, covering 674 patients, with follow-up ranging from 6 to 38.1 ± 29.7 months. Ischemic cause represented 490 (72.7%) patients; left ventricular ejection fraction varied from 25% ± 10% to 41.5% ± 13.8%. Dynamic mapping was used in 9 (57.1%) studies, 6 (37.5%) studies employed static techniques, and 1 (6.3%) study used a mixed approach. Procedure duration (P = .520) and complication incidence (P = .110) were similar between dynamic and static mapping modalities. The dynamic mapping subgroup exhibited significantly lower VT recurrence rate compared with the static mapping population (P < .010). This result persisted on a meta-regression model adjusted for ischemic cause and left ventricular ejection fraction, demonstrating that dynamic functional mapping was independently associated with lower recurrence rates (P = .005).<h4>Conclusion</h4>Functional mapping was demonstrated to be safe for VT ablation. Dynamic functional mapping independently associated with reduced postablation recurrence rates without significantly increasing procedure duration.