Kamrai tachycardiák katéterablatiós                     kezelése

Catheter ablation of ventricular tachycardias emerged significantly as standard therapy in the past 20 years. In this review recent advances in catheter ablation of ventricular tachycardias are discussed. The authors first present in details the technical aspects of ablation strategies, main indications and contraindications of ventricular tachycardia ablation and the necessary pre- and postinterventional diagnostic tests. Outcome is also discussed in different forms of ventricular tachycardias in detail. The authors summarize the safety and efficacy of catheter ablation of ventricular arrhythmias. They recommend that ablation of ventricular tachycardias should be considered earlier in patients with and without structural heart disease. Orv. Hetil., 2015, 156(25), 995–1002.

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Limitations and Challenges in Mapping Ventricular Tachycardia: New Technologies and Future Directions

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2017.20.1 ◽

2017 ◽

Vol 6 (3) ◽

pp. 118 ◽

Cited By ~ 12

Author(s):

Adam J Graham ◽

Michele Orini ◽

Pier D Lambiase ◽

◽

...

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Catheter Ablation ◽

New Technologies ◽

Therapeutic Option ◽

Myocardial Damage ◽

Structural Heart Disease ◽

Mortality And Morbidity ◽

Ventricular Tachycardia Ablation ◽

Life Saving

Recurrent episodes of ventricular tachycardia in patients with structural heart disease are associated with increased mortality and morbidity, despite the life-saving benefits of implantable cardiac defibrillators. Reducing implantable cardiac defibrillator therapies is important, as recurrent shocks can cause increased myocardial damage and stunning, despite the conversion of ventricular tachycardia/ventricular fibrillation. Catheter ablation has emerged as a potential therapeutic option either for primary or secondary prevention of these arrhythmias, particularly in post-myocardial infarction cases where the substrate is well defined. However, the outcomes of catheter ablation of ventricular tachycardia in structural heart disease remain unsatisfactory in comparison with other electrophysiological procedures. The disappointing efficacy of ventricular tachycardia ablation in structural heart disease is multifactorial. In this review, we discuss the issues surrounding this and examine the limitations of current mapping approaches, as well as newer technologies that might help address them.

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Catheter Ablation for Ventricular Arrhythmias

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2013.2.1.45 ◽

2013 ◽

Vol 2 (1) ◽

pp. 45 ◽

Cited By ~ 2

Author(s):

Eyal Nof ◽

William G Stevenson ◽

Roy M John ◽

◽

...

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Catheter Ablation ◽

Ventricular Arrhythmias ◽

Structural Heart Disease ◽

Success Rates ◽

Effective Treatment Option ◽

Cardioverter Defibrillator ◽

Mapping Techniques ◽

Catheter Technology

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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Safety and Efficacy of Catheter Ablation for Ventricular Tachycardia in Elderly Patients With Structural Heart Disease

JACC: Clinical Electrophysiology ◽

10.1016/j.jacep.2015.03.005 ◽

2015 ◽

Vol 1 (1-2) ◽

pp. 52-58 ◽

Cited By ~ 5

Author(s):

Jackson J. Liang ◽

Shaan Khurshid ◽

Robert D. Schaller ◽

Pasquale Santangeli ◽

Francis E. Marchlinski ◽

...

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Catheter Ablation ◽

Elderly Patients ◽

Structural Heart Disease ◽

Safety And Efficacy

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Catheter ablation of Idiopathic Ventricular Arrhythmias in Nepal-5 Years Single Centre Experience

Nepalese Heart Journal ◽

10.3126/njh.v18i2.40402 ◽

2021 ◽

Vol 18 (2) ◽

pp. 33-37

Author(s):

Roshan Raut ◽

Murari Dhungana ◽

Man Bahadur KC ◽

Mukunda Sharma ◽

Surakshya Joshi ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Ventricular Arrhythmias ◽

Clinical Success ◽

Electrophysiological Study ◽

Structural Heart Disease ◽

Left Ventricular ◽

Single Centre Experience ◽

Single Operator ◽

Acute Success

Background and Aims: Idiopathic ventricular arrhythmia (IVAs) is defined as premature ventricular complexes (PVCs), nonsustained ventricular tachycardia or sustained ventricular tachycardia (VT) in the absence of obvious structural heart disease. Catheter ablation has become an established treatment strategy for wide varieties of idiopathic ventricular arrhythmias. The aim of this study is to report the efficacy and safety of catheter ablation of idiopathic ventricular arrhythmias, for the first time in Nepal. Methods: This is a retrospective observational descriptive study of all patients who underwent electrophysiological study and radiofrequency catheter ablation for IVAs from March, 2015 to February 2020 at Shahid Gangalal National Heart center (SGNHC). Results: Altogether 101 patients underwent an EP study with intent to ablations for idiopathic ventricular arrhythmias. In 13 patients, ventricular arrhythmias were not present on the procedure day and also could not be induced in the lab, therefore ablation was performed in 88 patients only. RVOT was the most common site of these arrhythmias comprising 51% of all cases, followed by fascicular VT (34%) and basal left ventricular IVAs (15%). Out of 88 patients, the acute success of 7 patients could not be assessed because of very infrequent PVCs. Out of remaining 81 patients, acute success achieved in 77 patients (95%). Recurrence occurred in 9 patients (10.7%) and 4 patients underwent repeat ablation giving rise to over clinical success during follow up in 78 patients (88.7%). There were two major complications, one pulmonary embolism and another cardiac tamponade both managed successfully. Conclusion: This single-center single operator study demonstrates that catheter ablation of idiopathic ventricular arrhythmias has a high success and low complication rate

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Faculty Opinions recommendation of Long-term Outcomes of Ventricular Tachycardia Ablation in Different Types of Structural Heart Disease.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726122471.793533528 ◽

2017 ◽

Author(s):

Brian Olshansky

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Structural Heart Disease ◽

Long Term Outcomes ◽

Ventricular Tachycardia Ablation ◽

Different Types

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Minimising radiation exposure in catheter ablation of ventricular arrhythmias

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02120-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Matevž Jan ◽

David Žižek ◽

Tine Prolič Kalinšek ◽

Dimitrij Kuhelj ◽

Primož Trunk ◽

...

Keyword(s):

Catheter Ablation ◽

Radiation Exposure ◽

Ventricular Arrhythmias ◽

Major Complication ◽

Structural Heart Disease ◽

Left Ventricular ◽

Complex Nature ◽

Group 2 ◽

Procedural Outcomes ◽

Group 1

Abstract Background Conventional fluoroscopy guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs). However, with the complex nature of most procedures, patients and staff bare an increased radiation exposure. Near-zero or zero-fluoroscopy CA is an alternative method which could substantially reduce or even eliminate the radiation dose. Our aim was to analyse procedural outcomes with fluoroscopy minimising approach for treatment of VAs in patients with structurally normal hearts (SNH) and structural heart disease (SHD). Methods Fifty-two (age 53.4 ± 17.8 years, 38 male, 14 female) consecutive patients who underwent CA of VAs in our institution between May 2018 and December 2019 were included. Procedures were performed primarily with the aid of the three-dimensional electro-anatomical mapping system and intra-cardiac echocardiography. Fluoroscopy was considered only in left ventricular (LV) summit mapping for coronary angiography and when epicardial approach was planned. Acute and long-term procedural outcomes were analysed. Results Sixty CA procedures were performed. Twenty-five patients had SHD-related VAs (Group 1) and 27 patients had SNH (Group 2). While Group 1 had significantly higher total procedural time (256.9 ± 71.7 vs 123.6 ± 42.2 min; p < 0.001) compared to Group 2, overall procedural success rate [77.4% (24/31) vs 89.7% (26/29); p = 0.20)] and recurrence rate after the first procedure [8/25, (32%) vs 8/27, (29.6%); p = 0.85] were similar in both groups. Fluoroscopy was used in 3 procedures in Group 1 where epicardial approach was needed and in 4 procedures in Group 2 where LV summit VAs were ablated. Overall procedure-related major complication rate was 5%. Conclusions Fluoroscopy minimising approach for CA of VAs is feasible and safe in patients with SHD and SNH. Fluoroscopy could not be completely abolished in VAs with epicardial and LV summit substrate location.

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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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SafeTy and Efficacy of Direct Oral Anticoagulant versus Aspirin for Reduction Of RisK of CErebrovascular Events in Patients Undergoing Ventricular Tachycardia Ablation (STROKE-VT)

JACC: Clinical Electrophysiology ◽

10.1016/j.jacep.2021.07.010 ◽

2021 ◽

Author(s):

Dhanunjaya Lakkireddy ◽

Jayaprakash Shenthar ◽

Jalaj Garg ◽

Deepak Padmanabhan ◽

Rakesh Gopinathannair ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Oral Anticoagulant ◽

Direct Oral Anticoagulant ◽

Safety And Efficacy ◽

Ventricular Tachycardia Ablation ◽

Cerebrovascular Events

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Ventricular tachycardia ablation in nonischemic cardiomyopathy

EP Europace ◽

10.1093/europace/euab116.362 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

D Nascimento Matos ◽

D Cavaco ◽

P Carmo ◽

MS Carvalho ◽

G Rodrigues ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Left Ventricular ◽

Scientific Development ◽

Left Ventricular Ejection ◽

Drug Resistant ◽

Nonischemic Cardiomyopathy ◽

Epicardial Ablation ◽

Ventricular Ejection Fraction ◽

Ventricular Tachycardia Ablation

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Catheter ablation outcomes for drug-resistant ventricular tachycardia (VT) in nonischemic cardiomyopathy (NICM) are suboptimal when compared to ischemic cardiomyopathy. We aimed to analyse the long-term efficacy and safety of percutaneous catheter ablation in this subset of patients. METHODS Single-center observational retrospective registry including consecutive NICM patients who underwent catheter ablation for drug-resistant VT during a 10-year period. The efficacy endpoint was defined as VT-free survival after catheter ablation, while safety outcomes were defined by 30-days mortality and procedure-related complications. Independent predictors of VT recurrence were assessed by Cox regression. RESULTS In a population of 68 patients, most were male (85%), mean left ventricular ejection fraction (LVEF) was 34 ± 12%, and mean age was 58 ± 15 years. All patients had an implantable cardioverter-defibrillator. Twenty-six (38%) patients underwent epicardial ablation (table 1). Over a median follow-up of 3 years (IQR 1-8), 41% (n = 31) patients had VT recurrence and 28% died (n = 19). Multivariate survival analysis identified LVEF (HR= 0.98; 95%CI 0.92-0.99, p = 0.046) and VT storm at presentation (HR = 2.38; 95%CI 1.04-5.46, p = 0.041) as independent predictors of VT recurrence. The yearly rates of VT recurrence and overall mortality were 21%/year and 10%/year, respectively. No patients died at 30-days post-procedure, and mean hospital length of stay was 5 ± 6 days. The complication rate was 7% (n = 5, table 1), mostly in patients undergoing epicardial ablation (4 vs 1 in endocardial ablation, P = 0.046). CONCLUSION LVEF and VT storm at presentation were independent predictors of VT recurrence in NICM patients after catheter ablation. While clinical outcomes can be improved with further technical and scientific development, a tailored endocardial/epicardial approach was safe, with low overall number of complications and no 30-days mortality. Abstract Figure.

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