Ventricular tachycardia ablation
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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 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.
- 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.
Scar related ventricular arrhythmia
- 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 VT is in variable sites including epicardial surface of both ventricles, or midmyocardium where is difficul to approach.
- 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.