Ventricular tachycardia ablation: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Ventricular tachycardia}} | {{Ventricular tachycardia}} | ||
{{CMG}}; {{AE}} {{Rim}} | {{CMG}}; {{AE}} {{Sara.Zand}} {{Rim}} | ||
==Overview== | ==Overview== | ||
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* Area of ablation involves low [[electrogram voltage]]. | * 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> | *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> | ||
== Radiofrequency ablation == | == Radiofrequency ablation == | ||
Revision as of 04:50, 9 May 2021
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Ventricular tachycardia Microchapters |
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Differentiating Ventricular Tachycardia from other Disorders |
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Diagnosis |
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Treatment |
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Case Studies |
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Ventricular tachycardia ablation On the Web |
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Risk calculators and risk factors for Ventricular tachycardia ablation |
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
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
- 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.
- Mechanism and location of ventricular arrhythmia may determine The ablation strategy, risks and outcomes.
- The location of ventricular arrhythmia maybe subendocardium or subepicardium.
- Approach for ablation of ventricular arrhythmia originated subendocardium can be done through a transvenous for the right ventricle or transaortic/transeptal f 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.
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 to find the earliest site of ventricular activation or ventricular pacing for inaccessible sites.
- The most common ventricular arrhythmia in structurally heart disease is sustained monomorphic reentry ventricular tachycardia related to scar formation.
- The reentry substrate for VT in myocardial infarction is sunendocardium.
- For non-ischemic cardiomyopathy the substrate of reentry aVT is in variable sites including epicardial surface of both ventricles, or midmyocardium with dificuly for accesss.
- Area of ablation involves low electrogram voltage.
- Based on electrocardiographic and pacing characteristics during sinus rhythm, the reentry circuit substrate is approached for ablation.[1]
Radiofrequency ablation
- 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.[2]
2006 ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT) [2]
Ablation (DO NOT EDIT) [2]
| Class I |
| "1. Ablation is indicated in patients who are otherwise at low risk for SCD and have sustained predominantly monomorphic VT that is drug resistant, who are drug intolerant, or who do not wish long-term drug therapy. (Level of Evidence: C) " |
| "2. Ablation is indicated in patients with bundle branch reentrant VT. (Level of Evidence: C) " |
| "3. 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. (Level of Evidence: C)[3][4] " |
| "4. Ablation is indicated in patients with Wolff-Parkinson-White syndrome resuscitated from sudden cardiac arrest due to atrial fibrillation and rapid conduction over the accessory pathway causing VF. (Level of Evidence: B)[5] " |
| Class III |
| "1. Ablation of asymptomatic relatively infrequent PVCs is not indicated. (Level of Evidence: C)" |
| Class IIa |
| "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.(Level of Evidence: C)" |
| " 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.(Level of Evidence: C)" |
| " 3. Ablation can be useful in symptomatic patients with Wolff-Parkinson-White syndrome who have accessory pathways with refractory periods less than 240 ms in duration. (Level of Evidence: B)[5]" |
| Class IIb |
| 1. "Ablation of Purkinje fiber potentials may be considered in patients with ventricular arrhythmia storm consistently provoked by PVCs of similar morphology. (Level of Evidence: C)[6]" |
| 2. "Ablation of asymptomatic PVCs may be considered when the PVCs are very frequent to avoid or treat tachycardia-induced cardiomyopathy. (Level of Evidence: C)[7]" |
References
- ↑ 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.
- ↑ 2.0 2.1 2.2 Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M; et al. (2006). "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". Circulation. 114 (10): e385–484. doi:10.1161/CIRCULATIONAHA.106.178233. PMID 16935995.
- ↑ Bhandari AK, Shapiro WA, Morady F, Shen EN, Mason J, Scheinman MM (1985). "Electrophysiologic testing in patients with the long QT syndrome". Circulation. 71 (1): 63–71. PMID 2856866.
- ↑ Silva RM, Mont L, Nava S, Rojel U, Matas M, Brugada J (2004). "Radiofrequency catheter ablation for arrhythmic storm in patients with an implantable cardioverter defibrillator". Pacing Clin Electrophysiol. 27 (7): 971–5. doi:10.1111/j.1540-8159.2004.00567.x. PMID 15271018.
- ↑ 5.0 5.1 {{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
- ↑ Haïssaguerre M, Shoda M, Jaïs P, Nogami A, Shah DC, Kautzner J; et al. (2002). "Mapping and ablation of idiopathic ventricular fibrillation". Circulation. 106 (8): 962–7. PMID 12186801.
- ↑ Takemoto M, Yoshimura H, Ohba Y, Matsumoto Y, Yamamoto U, Mohri M; et al. (2005). "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". J Am Coll Cardiol. 45 (8): 1259–65. doi:10.1016/j.jacc.2004.12.073. PMID 15837259.