What are LAVA signals and their use?

• A. Local Abnormal Ventricular Activations
• B. Local Atrial Ventricular Activations
• C. Late Activation Velocity Anomalies
• D. Linear Activation Variants

Answer: (A)

LAVA signals are Local Abnormal Ventricular Activations, a type of local electrogram seen during substrate mapping for scar-related ventricular tachycardia. They originate from diseased myocardium within scar tissue or its border zones, where conduction becomes slow and highly fragmented. These signals typically appear as late, often fragmented or high-frequency activations at a mapping site and indicate slow conduction channels that can form part of a VT circuit. Identifying and targeting LAVA during ablation allows modification of the substrate to disrupt these slow conduction pathways, reducing VT induction and burden. Mapping is usually done with high-density catheters during sinus rhythm or paced rhythm, and ablation focuses on eliminating or homogenizing areas showing LAVA to prevent reentrant circuits.