前半（講演：AI翻訳付）
Dr. Rod Tung’s VT Mapping Strategy：A Toolkit for Localizing VT Circuitry
演者
Nathaniel Shatz
Abbott
抄録
VT is known to be a high-risk, complex, and time-consuming procedure. Unlike atrial arrhythmia, mapping in VT often brings hemodynamic risk to patients.
To reduce risk, scar homogenization in a baseline rhythm has emerged as the gold standard for VT ablation.
But in patients with extensive scar, not all scar contributes to VT circuitry, and significant regions may be unnecessarily ablated.
In addition, treating all scar, critical and non-critical, as equal may reduce ablation intentionality in critical VT circuitry regions, especially for intramural and 3D VT circuits.
There is a clinical need to improve the specificity of identifying VT circuitry without compromising patient hemodynamics.
Over the years, many strategies have emerged in locating and targeting the VT circuit with more specificity than scar mapping.
Dr. Tung has published that critical circuitry depends on locating lines of block (LOB) that contribute to the VT circuitry.
But about 50% of the time, lines of block are concealed or inaccessible. Thus, Dr. Tung utilizes many “tools” to uncover critical VT circuitry and lines of block.
This “tool kit” includes but is not limited to Isochronal Late Activation Mapping (ILAM), frequency analysis, pace-mapping, differential pacing, multiple wavefront mapping, Strategic Multielectrode Positioning (STaMP), Entrainment, and ICE visualization.
Not only do each of these VT mapping tools further specify critical VT circuitry, but also, they each gain new meaning and utility in the context of the information gained from each of the other tools.
Understanding the entire VT Mapping Toolkit and how each of the tools interact and aid each other is crucial for developing a streamlined VT mapping and ablation strategy.
Dr. Tung’s workflow recognizes that VT cases are widely variable, and not all tools can be applied in the same way for each patient.
This variance includes 3D vs 2D VT, substrate size and characteristics, baseline wavefronts, and VT inducibility. Under these circumstances, knowing how and when to apply each tool greatly improves trajectory of the entire VT procedure.
Though an understanding and intentional utilization of the VT mapping toolkit, critical VT circuitry can be reliably identified with improved specificity, improving our understanding of VT mechanisms and potentially reducing unnecessary ablation.
後半（症例ディスカッション）
Maximizing Ensite X Features in VT Mapping and Ablation
講師
濵﨑 誠之
横須賀共済病院臨床工学科
Meet the Super Mapper2（CARTO）
7月25日（土） 8:30～9:30 第7会場（アネックスホールA）
座長
倉田 征昭
昭和医科大学藤が丘病院循環器内科
新城 卓美
亀田総合病院ME室
前半（講演：AI翻訳付）
Beyond the Map：The Role of CARTO Clinical Support in VT Ablation
演者
Steven Touchton Jr.
Johnson & Johnson MedTech
抄録
Ventricular tachycardia ablation is among the most complex and high-stakes procedures in electrophysiology, requiring precise coordination between physician strategy, mapping technology, and clinical support. Clinical support can meaningfully improve the efficiency, clarity, and procedural value of VT ablation. Rather than viewing support as solely system operation, it should be used as a workflow partnership in which the clinical specialist helps translate CARTO data into actionable procedural insight. High-value support begins before the case through thoughtful preparation, including review of substrate expectations, prior ablation history, ICD therapies, ECG clues, imaging, and anticipated procedural complexity. Once the case begins, early technical discipline is essential. Reference stability, accurate geometry, helpful views, and ICE integration all influence downstream map reliability. Clear, reliable maps increase physician confidence and help the case progress more efficiently. Annotation accuracy, point density, unique electrogram identification and tagging, and appropriate rhythm interpretation are foundational elements of dependable mapping. Advanced CARTO software, including Late Annotation Mapping, parallel mapping, LAT velocity vectors, and LAT map coloring, can elucidate scar-related substrate, slow conduction, isochronal crowding, and wavefront behavior. In substrate-based VT ablation, clinical support adds value by helping clarify scar patterns, border zones, channels, and potential targets. When activation or entrainment mapping is possible, support must help the team capitalize on limited mapping time through speed, organization, and anticipation. In unstable or high-risk VT cases, effective support becomes even more important by preserving procedural flow and technical control while remaining aligned with safety priorities. Exceptional support is defined by technical command combined with anticipation, situational awareness, concise communication, and alignment with the physician’s strategy. Ultimately, CARTO delivers its greatest value when powerful tools are paired with thoughtful preparation and skilled clinical support. This allows the team to create trustworthy maps, recognize critical substrate, and move confidently toward efficient, informed ablation decisions.
後半（症例ディスカッション）
Mastering VT Mapping：Case-Based Learning from CARTO expert
