High frequency electrograms abolition as a valuable target for remap during ventricular tachycardia ablation. The HF REMAP study
D Valente, F M Cauti, M Magnocavallo, D Ricciardi, F Fioravanti, N Tanese, P Rossi, A Radinovic, L Rampa, F Calore, G Peretto, A Barengo, P Della BellaAbstract
Background
Peak frequency (PF) analysis has recently emerged as a novel tool to assess electrogram properties through their frequency spectrum. PF is an indirect marker of local myocardial activity, and its reduction after radiofrequency ablation reflects effective tissue modification.
Purpose
Our study aims to evaluate PF analysis as an objective method to confirm lesion efficacy during ventricular tachycardia (VT) ablation.
Methods
We retrospectively analysed 43 (out of 247) consecutive patients who underwent VT ablation between January 2023 and December 2024, using a multipolar high-density grid-shaped catheter. Complete pre- and post-ablation high-density sinus rhythm maps were obtained. PF analysis was applied offline to quantify the residual high frequency (HF) electrogram burden, expressed as a percentage of the ablated area. Patients were stratified according to residual HF burden, and outcomes were assessed with Kaplan-Meier survival analysis and Cox regression analysis.
Results
During a median follow-up of 372 days, eleven patients reached the primary endpoint (VT recurrence or arrhythmic storm). Patients with <70% residual HF post-ablation had significantly higher VT-free survival (≈90% at 12 months) compared to those with ≥70% residual HF (≈25%; log-rank p<0.001). Cox regression confirmed residual HF ≥70% as an independent predictor of recurrence (HR 13.36; 95% CI 3.52–50.7; p<0.001).
Conclusion
PF analysis during remapping provides an operator-independent, reproducible tool to confirm lesion efficacy. A low post-ablation residual HF burden is associated to a significantly increased VAs-free survival rate.