Ventricular tachycardia ablation
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Differentiating Ventricular Tachycardia from other Disorders |
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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
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 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.
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 site of 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 difficuly to 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]
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.