Catheter Ablation for Ventricular Arrhythmias

Catheter ablation has emerged as an important and effective treatment option for many recurrent ventricular arrhythmias. The approach to ablation and the risks and outcomes are largely determined by the nature of the severity and type of underlying heart disease. In patients with structural heart disease, catheter ablation can effectively reduce ventricular tachycardia (VT) episodes and implantable cardioverter defibrillator (ICD) shocks. For VT and symptomatic premature ventricular beats that occur in the absence of structural heart disease, catheter ablation is often effective as the sole therapy. Advances in catheter technology, imaging and mapping techniques have improved success rates for ablation. This review discusses current approaches to mapping and ablation for ventricular arrhythmias.

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Mechanisms and Clinical Management of Ventricular Arrhythmias following Blunt Chest Trauma

Cardiology Research and Practice ◽

10.1155/2016/7270247 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Daniel H. Wolbrom ◽

Aleef Rahman ◽

Cory M. Tschabrunn

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Ventricular Arrhythmias ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Motor Vehicle ◽

Structural Heart Disease ◽

Chest Injury ◽

Chronic Stage ◽

Chest Wall Injury

Nonpenetrating, blunt chest trauma is a serious medical condition with varied clinical presentations and implications. This can be the result of a dense projectile during competitive and recreational sports but may also include other etiologies such as motor vehicle accidents or traumatic falls. In this setting, the manifestation of ventricular arrhythmias has been observed both acutely and chronically. This is based on two entirely separate mechanisms and etiologies requiring different treatments. Ventricular fibrillation can occur immediately after chest wall injury (commotio cordis) and requires rapid defibrillation. Monomorphic ventricular tachycardia can develop in the chronic stage due to underlying structural heart disease long after blunt chest injury. The associated arrhythmogenic tissue may be complex and provides the necessary substrate to form a reentrant VT circuit. Ventricular tachycardia in the absence of overt structural heart disease appears to be focal in nature with rapid termination during ablation. Regardless of the VT mechanism, patients with recurrent episodes, despite antiarrhythmic medication in the chronic stage following blunt chest injury, are likely to require ablation to achieve VT control. This review article will describe the mechanisms, pathophysiology, and treatment of ventricular arrhythmias that occur in both the acute and chronic stages following blunt chest trauma.

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Combined Endocardial-Epicardial Versus Endocardial Catheter Ablation Alone for Ventricular Tachycardia in Structural Heart Disease

JACC: Clinical Electrophysiology ◽

10.1016/j.jacep.2018.08.010 ◽

2019 ◽

Vol 5 (1) ◽

pp. 13-24 ◽

Cited By ~ 18

Author(s):

Jorge Romero ◽

Roberto C. Cerrud-Rodriguez ◽

Luigi Di Biase ◽

Juan Carlos Diaz ◽

Isabella Alviz ◽

...

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Catheter Ablation ◽

Structural Heart Disease

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Percutaneous ventricular assist devices for catheter ablation of ventricular tachycardia in structural heart disease: “A Conditio Sine Qua Non”?

Journal of Cardiovascular Electrophysiology ◽

10.1111/jce.13335 ◽

2017 ◽

Vol 28 (11) ◽

pp. 1303-1305 ◽

Cited By ~ 1

Author(s):

Jorge Romero ◽

Luigi Di Biase

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Catheter Ablation ◽

Structural Heart Disease ◽

Ventricular Assist Devices ◽

Ventricular Assist ◽

Assist Devices

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Sustained and non-sustained ventricular tachycardia and no associated heart disease (idiopathic ventricular tachycardia)

ESC CardioMed ◽

10.1093/med/9780198784906.003.0540_update_001 ◽

2018 ◽

pp. 2288-2293

Author(s):

Victor Bazan ◽

Enrique Rodriguez-Font ◽

Francis E. Marchlinski

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Drug Therapy ◽

Catheter Ablation ◽

Beta Blockers ◽

Young Patients ◽

Structural Heart Disease ◽

Holter Monitoring ◽

Severe Arrhythmia ◽

The Right

Around 10% of ventricular arrhythmias (VA) occur in the absence of underlying structural heart disease. These so-called ‘idiopathic’ VAs usually have a benign clinical course. Only rarely do these “benign” arrhythmias trigger polymorphic ventricular tachycardia (PVT) and idiopathic ventricular fibrillation (VF). Due to their focal origin and to the absence of underlying myocardial scar, the 12-lead ECG very precisely establishes the right (RV) or left (LV) ventricular site of origin of the arrhythmia and can help regionalizing the origin of VT for ablation. A 12-lead ECG obtained during the baseline rhythm and 24-hour ECG Holter monitoring are indicated in order to identify structural or electrical disorders leading to PVT/VF and to determine the VA burden. The most frequent origin of idiopathic VAs is the RV outflow tract (OT). Other origins include the LVOT, the LV fascicles (fascicular VTs), the LV and RV papillary muscles, the crux cordis, the mitral and tricuspid annuli and the RV moderator band. Recognizing the typical anatomic sites of origin combined with a 12 lead ECG assessment facilitates localization. Antiarrhythmic drug therapy (including use of beta-blockers) or catheter ablation may be indicated to suppress or eliminate idiopathic VAs, particularly upon severe arrhythmia-related symptoms or if the arrhythmia burden is high and ‘tachycardia’-induced cardiomyopathy is suspected. Catheter ablation is frequently preferred to prevent lifelong drug therapy in young patients.

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Sustained monomorphic ventricular tachycardia: the role of catheter ablation

ESC CardioMed ◽

10.1093/med/9780198784906.003.0539 ◽

2018 ◽

pp. 2279-2288

Author(s):

Tilman Maurer ◽

William G. Stevenson ◽

Karl-Heinz Kuck

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Catheter Ablation ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Therapeutic Option ◽

Structural Heart Disease ◽

Premature Ventricular Contractions ◽

Monomorphic Ventricular Tachycardia ◽

Premature Beats

Monomorphic ventricular tachycardia (VT) may occur in the presence or absence of structural heart disease. The standard therapy for patients with structural heart disease at high risk of sudden cardiac death due to VT is the implantable cardioverter defibrillator (ICD). While ICDs effectively terminate VT and prevent sudden cardiac death, they do not prevent recurrent episodes of VT, since the underlying arrhythmogenic substrate remains unchanged. However, shocks from an ICD increase mortality and impair quality of life. These limitations as well as continuous advancements in technology have made catheter ablation an important treatment strategy for patients with structural heart disease presenting with VT. Idiopathic ventricular arrhythmias include premature ventricular contractions and VT occurring in the absence of overt structural heart disease. In this setting, catheter ablation has evolved as the primary therapeutic option for symptomatic ventricular premature beats and sustained VTs and is curative in most cases. This chapter presents an overview of the principles of invasive diagnosis and treatment of monomorphic VTs in patients with and without structural heart disease and delineates the clinical outcome of catheter ablation. Finally, the chapter provides an outlook to the future, discussing potential directions and upcoming developments in the field of catheter ablation of monomorphic VT.

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