Radcliffe Cardiology

A virtual event by Radcliffe Cardiology

Session 4.6 - Case & Discussion: Beyond the Circuit: Tackling the VT Substrate

This session, run by Andre d’Avila (Boston, US), presents Beyond the Circuit Tackling the VT Substrate, illustrating how multielectrode mapping, wavefront manipulation and “waddle” analysis can identify small critical VT channels within large low-voltage scars, enabling targeted ablation of only 10–15% of the substrate while avoiding prolonged VT induction and full scar homogenisation, including complex epicardial cases. In discussion, Fermin Garcia (Philadelphia, US) and Timothy Maher (Boston, US) highlight the limits of surface mapping in intramural disease, the importance of varying activation wavefronts, integrating imaging and being ready to pivot to induction, pace mapping or alternative strategies when channels or late potentials are not evident, while moderator Devi Nair (Jonesboro, US) underlines that successful VT substrate ablation demands multiple complementary tools rather than reliance on a single technique.

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