Perspective:

Traditionally, the identification of the successful target sites for VT ablation post MI required induction of the VT and mapping using activation times during the tachycardia. Not all clinical VT circuits can be successfully induced during programmed stimulation, and not all VTs are hemodynamically stable to allow a prolonged period of mapping. A complementary approach has been voltage mapping and pace mapping. The authors of the current manuscript have developed novel computational models utilizing magnetic resonance imaging and RVI mapping. RVI can detect multiple potential entry and exit sites of a re-entrant arrhythmia by examining the spatiotemporal relationship between activation and repolarization times of a premature beat, and it obviates the necessity to induce the arrhythmia. In this proof-of-concept study the authors demonstrated that the computationally derived isthmus and exit sites can guide ablation and that this method may require less extensive ablation. Additionally, the induction of the arrhythmia is not necessary for the success of this approach.