Ventricular tachycardia ablation: Difference between revisions

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{{Ventricular tachycardia}}
{{Ventricular tachycardia}}
{{CMG}}; {{AE}} {{Rim}}
{{CMG}}; {{AE}} {{Sara.Zand}} {{Rim}}


==Overview==
==Overview==
[[Radiofrequency ablation]] is used for the treatment of ventricular tachycardia in [[patients]] with [[left ventricular dysfunction]] secondary to previous [[MI]], [[bundle branch]] reentry circuits, [[cardiomyopathy]] as well as in [[idiopathic]] cases.
[[Catheter ablation]] is useful for treating [[ventricular arrhythmia]] when drugs are ineffective. [[Monomorphic VT]] is a  suitable target for [[ablation]]. Ablation can be used for [[polymorphic VT]] or [[VF]] if an initiating [[PVC]] focus or substrate is accessible.


==[[Catheter ablation]]==
==[[Catheter ablation]]==
* [[Catheter ablation]] is useful for treating [[ventricular arrhythmia]] when drugs are ineffective.
* [[Catheter ablation]] is useful for treating [[ventricular arrhythmia]] when drugs are ineffective.
* [[Monomorphic VT]] is a  suitable target for [[ablation]].
* [[Monomorphic VT]] is a  suitable target for [[ablation]].
* Ablation can be used for [[polymorphic VT]] or [[VF]] if an initiating [[PVC]] focus or substrate is accessable.
* Ablation can be used for [[polymorphic VT]] or [[VF]] if an initiating [[PVC]] focus or substrate is accessible.
* Mechanism and location of [[ventricular arrhythmia]] may determine The [[ablation]] strategy, risks and outcomes.
* Mechanism and location of [[ventricular arrhythmia]] may determine The [[ablation]] strategy, risks and outcomes.
* The location of [[ventricular arrhythmia]] maybe subendocardium]] or [[subepicardium]].
* The location of [[ventricular arrhythmia]] maybe [[subendocardium]] or [[subepicardium]].
* Approach for ablation can be done through a [[transvenous]] for the [[right ventricle]] or [[transaortic]]/[[transeptal]] for the [[left ventricle]]  subendocardium [[ventricular arrhythmia]].
* Approach for ablation of [[ventricular arrhythmia]] originated subendocardium can be done through a [[transvenous]] for the [[right ventricle]] or [[transaortic]]/[[transeptal]] of the [[left ventricle]].  
* [[percutaneous ]] [[subxiphoid]] puncture is used for [[pericardial]] access.
* [[Programmed electrical stimulation]] by catheter is attempted for induction of [[ventricular arrhythmia]] and ablation.
* In some [[cardiomyopathies]] the location of [[ventricular arrhythmia]] in the [[myocardium]] is inaccessible or in idiopathic [[ventricular arrhythmia]] induction of [[ventricular arrhythmia]] for mapping is difficult.


== Radiofrequency ablation ==
== [[Ventricular arrhythmia]] in [[structurally normal heart]]==
* Ideopathic [[ventricular arrhythmia]] appears in structurally normal [[heart]] or without genetic predisposition disorders.
* [[Monomorphic ventricular arrhythmia]] is the Most common [[idiopathic ventricular arrhythmia]] 
* The underlying mechanism of [[ventricular arrhythmia]] is [[triggered activity ]] or abnormal [[automaticity]], or rarely [[reentry]].
* [[Catheter ablation]] is a choice approach for symptomatic [[patients]] or when [[antiarrhythmic medications]] is ineffective or not tolerated.
* The aim of the approach is finding the earliest site of [[ventricular]] activation or  [[ventricular]] pacing for inaccessible sites.


*[[Radiofrequency ablation]] is used for the treatment of ventricular tachycardia in patients with [[left ventricular dysfunction]] secondary to previous [[MI]], [[bundle branch]] reentry circuits, [[cardiomyopathy]] as well as in [[idiopathic]] cases.<ref name="pmid16935995">{{cite journal| author=Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al.| title=ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=Circulation | year= 2006 | volume= 114 | issue= 10 | pages= e385-484 | pmid=16935995 | doi=10.1161/CIRCULATIONAHA.106.178233 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16935995}}</ref>
==[[Scar]] related [[ventricular arrhythmia]]==
 
* The most common [[ventricular arrhythmia]] in [[structurally heart disease]] is sustained monomorphic reentry [[ventricular tachycardia]] related to [[scar formation]].
== 2006 ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT) <ref name="pmid16935995">{{cite journal| author=Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al.| title=ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=Circulation | year= 2006 | volume= 114 | issue= 10 | pages= e385-484 | pmid=16935995 | doi=10.1161/CIRCULATIONAHA.106.178233 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16935995}}</ref>==
* The site of reentry substrate for [[VT]] in [[myocardial infarction ]] is [[sunendocardium]].
 
* For [[non-ischemic cardiomyopathy]] the substrate of reentry [[VT]] is in variable sites including [[epicardial]] surface of both [[ventricles]], or [[midmyocardium]] where is difficul to approach.  
===Ablation (DO NOT EDIT) <ref name="pmid16935995">{{cite journal| author=Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al.| title=ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=Circulation | year= 2006 | volume= 114 | issue= 10 | pages= e385-484 | pmid=16935995 | doi=10.1161/CIRCULATIONAHA.106.178233 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16935995}}</ref>===
* Area of ablation involves low [[electrogram voltage]].
 
* Based on [[electrocardiographic]] and pacing characteristics during [[sinus rhythm]], the [[reentry]] circuit substrate is approached for [[ablation]].<ref name="AliotStevenson2009">{{cite journal|last1=Aliot|first1=Etienne M.|last2=Stevenson|first2=William G.|last3=Almendral-Garrote|first3=Jesus Ma|last4=Bogun|first4=Frank|last5=Calkins|first5=C. Hugh|last6=Delacretaz|first6=Etienne|last7=Della Bella|first7=Paolo|last8=Hindricks|first8=Gerhard|last9=Jaïs|first9=Pierre|last10=Josephson|first10=Mark E.|last11=Kautzner|first11=Josef|last12=Kay|first12=G. Neal|last13=Kuck|first13=Karl-Heinz|last14=Lerman|first14=Bruce B.|last15=Marchlinski|first15=Francis|last16=Reddy|first16=Vivek|last17=Schalij|first17=Martin-Jan|last18=Schilling|first18=Richard|last19=Soejima|first19=Kyoko|last20=Wilber|first20=David|title=EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias|journal=Heart Rhythm|volume=6|issue=6|year=2009|pages=886–933|issn=15475271|doi=10.1016/j.hrthm.2009.04.030}}</ref>
{| class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' [[Catheter ablation|Ablation]] is indicated in patients who are otherwise at low risk for [[Sudden Cardiac Death|SCD]] and have sustained predominantly [[monomorphic ventricular tachycardia|monomorphic VT]] that is drug resistant, who are drug intolerant, or who do not wish long-term drug therapy. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''2.''' [[Catheter ablation|Ablation]] is indicated in patients with [[Bundle branch reentrant ventricular tachycardia|bundle branch reentrant VT]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''3.''' [[Catheter ablation|Ablation]] is indicated as adjunctive therapy in patients with an [[ICD]] who are receiving multiple shocks as a result of [[sustained VT]] that is not manageable by reprogramming or changing drug therapy or who do not wish long-term drug therapy. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<ref name="pmid2856866">{{cite journal| author=Bhandari AK, Shapiro WA, Morady F, Shen EN, Mason J, Scheinman MM| title=Electrophysiologic testing in patients with the long QT syndrome. | journal=Circulation | year= 1985 | volume= 71 | issue= 1 | pages= 63-71 | pmid=2856866 | doi= | pmc= | url= }} </ref><ref name="pmid15271018">{{cite journal| author=Silva RM, Mont L, Nava S, Rojel U, Matas M, Brugada J| title=Radiofrequency catheter ablation for arrhythmic storm in patients with an implantable cardioverter defibrillator. | journal=Pacing Clin Electrophysiol | year= 2004 | volume= 27 | issue= 7 | pages= 971-5 | pmid=15271018 | doi=10.1111/j.1540-8159.2004.00567.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15271018  }} </ref> <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''4.''' [[Catheter ablation|Ablation]] is indicated in patients with [[WPW syndrome|Wolff-Parkinson-White syndrome]] resuscitated from [[sudden cardiac arrest]] due to [[atrial fibrillation]] and rapid conduction over the accessory pathway causing [[VF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<ref name="pmid14602878"><nowiki>{{cite journal| author=Pappone C, Santinelli V, Manguso F, Augello G, Santinelli O, Vicedomini G et al.| title=A randomized study of prophylactic catheter ablation in asymptomatic patients with the Wolff-Parkinson-White syndrome. | journal=N Engl J Med | year= 2003 | volume= 349 | issue= 19 | pages= 1803-11 | pmid=14602878 | doi=10.1056/NEJMoa035345 | pmc= | url=</nowiki>http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14602878</ref> <nowiki>"</nowiki>
|}
 
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
|bgcolor="LightCoral"| <nowiki>"</nowiki>'''1.''' [[Catheter ablation|Ablation]] of asymptomatic relatively infrequent [[PVCs]] is not indicated. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Ablation can be useful therapy in patients who are otherwise at low risk for [[SCD]] and have symptomatic [[nonsustained monomorphic VT]] that is drug resistant, who are drug intolerant or who do not wish long-term drug therapy.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki> '''2.''' Ablation can be useful therapy in patients who are otherwise at low risk for [[SCD]] and have frequent symptomatic predominantly [[monomorphic PVCs]] that are drug resistant or who are drug intolerant or who do not wish long-term drug therapy.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki> '''3.''' [[Catheter ablation|Ablation]] can be useful in symptomatic patients with [[WPW syndrome|Wolff-Parkinson-White syndrome]] who have [[accessory pathways]] with refractory periods less than 240 ms in duration. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<ref name="pmid14602878">{{cite journal| author=Pappone C, Santinelli V, Manguso F, Augello G, Santinelli O, Vicedomini G et al.| title=A randomized study of prophylactic catheter ablation in asymptomatic patients with the Wolff-Parkinson-White syndrome. | journal=N Engl J Med | year= 2003 | volume= 349 | issue= 19 | pages= 1803-11 | pmid=14602878 | doi=10.1056/NEJMoa035345 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14602878  }} </ref><nowiki>"</nowiki>
|}
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"| <nowiki></nowiki> '''1.''' "Ablation of [[Purkinje fiber]] potentials may be considered in patients with [[ventricular arrhythmia]] storm consistently provoked by [[PVCs]] of similar morphology. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<ref name="pmid12186801">{{cite journal| author=Haïssaguerre M, Shoda M, Jaïs P, Nogami A, Shah DC, Kautzner J et al.| title=Mapping and ablation of idiopathic ventricular fibrillation. | journal=Circulation | year= 2002 | volume= 106 | issue= 8 | pages= 962-7 | pmid=12186801 | doi= | pmc= | url= }} </ref><nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"| <nowiki></nowiki> '''2.''' "[[Catheter ablation|Ablation]] of asymptomatic [[PVCs]] may be considered when the PVCs are very frequent to avoid or treat [[cardiomyopathy|tachycardia-induced cardiomyopathy]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<ref name="pmid15837259">{{cite journal| author=Takemoto M, Yoshimura H, Ohba Y, Matsumoto Y, Yamamoto U, Mohri M et al.| title=Radiofrequency catheter ablation of premature ventricular complexes from right ventricular outflow tract improves left ventricular dilation and clinical status in patients without structural heart disease. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 8 | pages= 1259-65 | pmid=15837259 | doi=10.1016/j.jacc.2004.12.073 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15837259  }} </ref><nowiki>"</nowiki>
|}


==References==
==References==

Latest revision as of 08:54, 27 May 2021

Ventricular tachycardia Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Rim Halaby, M.D. [3]

Overview

Catheter ablation is useful for treating ventricular arrhythmia when drugs are ineffective. Monomorphic VT is a suitable target for ablation. Ablation can be used for polymorphic VT or VF if an initiating PVC focus or substrate is accessible.

Catheter ablation

Ventricular arrhythmia in structurally normal heart

Scar related ventricular arrhythmia

References

  1. ↑ Aliot, Etienne M.; Stevenson, William G.; Almendral-Garrote, Jesus Ma; Bogun, Frank; Calkins, C. Hugh; Delacretaz, Etienne; Della Bella, Paolo; Hindricks, Gerhard; Jaïs, Pierre; Josephson, Mark E.; Kautzner, Josef; Kay, G. Neal; Kuck, Karl-Heinz; Lerman, Bruce B.; Marchlinski, Francis; Reddy, Vivek; Schalij, Martin-Jan; Schilling, Richard; Soejima, Kyoko; Wilber, David (2009). "EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias". Heart Rhythm. 6 (6): 886–933. doi:10.1016/j.hrthm.2009.04.030. ISSN 1547-5271.

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