title: Substrate mapping and ablation for ventricular tachycardia: the LAVA approach.
abstract: BACKGROUND
  Catheter ablation of ventricular tachycardia (VT) is proven effective therapy particularly in patients with frequent defibrillator shocks. However, the optimal endpoint for VT ablation has been debated and additional endpoints have been proposed. At the same time, ablation strategies aiming at homogenizing the substrate of scar-related VT have been reported.
  
  
  RESULTS
  Our method to homogenize the substrate consists of local abnormal ventricular activity (LAVA) elimination. LAVA are high-frequency sharp signals that represent near-field signals of slowly conducting tissue and hence potential VT isthmuses. Pacing maneuvers are sometimes required to differentiate them from far-field signals. Delayed enhancement on cardiac MRI and/or wall thinning on multidetector computed tomography are also extremely helpful to identify the areas of interest during ablation. A strategy aiming at careful LAVA mapping, ablation, and elimination is feasible and can be achieved in about 70% of patients with scar-related VT. Complete LAVA elimination is associated with a better outcome when compared to LAVA persistence even when VT is rendered noninducible.
  
  
  CONCLUSIONS
  This is a simple approach, with a clear endpoint and the ability to ablate in sinus rhythm. This strategy significantly benefits from high-definition imaging, mapping, and epicardial access.
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Bordeaux University, INSERM 1045, Bordeaux-Pessac, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Sacher
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Bordeaux University, INSERM 1045, Bordeaux-Pessac, France.
authors.forename: Han S
authors.initials: HS
authors.lastname: Lim
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Bordeaux University, INSERM 1045, Bordeaux-Pessac, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Bordeaux University, INSERM 1045, Bordeaux-Pessac, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Denis
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Bordeaux University, INSERM 1045, Bordeaux-Pessac, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Berte
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Bordeaux University, INSERM 1045, Bordeaux-Pessac, France.
authors.forename: Seigo
authors.initials: S
authors.lastname: Yamashita
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Bordeaux University, INSERM 1045, Bordeaux-Pessac, France.
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Bordeaux University, INSERM 1045, Bordeaux-Pessac, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Haissaguerre
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Bordeaux University, INSERM 1045, Bordeaux-Pessac, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
mesh_terms: D000200:Action Potentials; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation / Q000379:methods*; D017023:Coronary Angiography; D022062:Electrophysiologic Techniques, Cardiac; D006339:Heart Rate; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D011237:Predictive Value of Tests; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: catheter ablation; imaging; ventricular tachycardia