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. 2015 Dec;4(3):184-8.
doi: 10.15420/aer.2015.4.3.184. Epub 2015 Dec 1.

Selecting the Appropriate Ablation Strategy: the Role of Endocardial and/or Epicardial Access

Mario Njeim  1 , Frank Bogun  1
Affiliations

Selecting the Appropriate Ablation Strategy: the Role of Endocardial and/or Epicardial Access

Mario Njeim et al. Arrhythm Electrophysiol Rev. 2015 Dec.

Abstract

Percutaneous catheter ablation has emerged as an effective treatment modality for the management of ventricular tachycardia. Despite years of progress in this field, the role of epicardial mapping and ablation needs to be further refined. In this review, we discuss the relationship between the type of underlying heart disease and the location of the arrythmogenic substrate as it pertains to a procedural approach. We describe the contribution of preprocedural and intraprocedural diagnostic tools for the localisation of the arrhythmogenic substrate, with a special emphasis on cardiac MRI and electrophysiological mapping. In our opinion, the preferred approach to target ventricular tachycardia should depend on the patient's underlying heart disease and the location of scar tissue, which can be best visualised using cardiac MRI.

Keywords: Catheter ablation; MRI; delayed enhancement; endocardial; epicardial; ventricular tachycardia.

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Figures

Figure 1:
Figure 1:. Delayed-enhanced MRI in a Patient with Prior Inferoseptal Myocardial Infarction
Figure 2:
Figure 2:. Delayed-enhanced MRI of Intramural Scar in a Patient with Nonischaemic Cardiomyopathy
Figure 3:
Figure 3:. Delayed Enhanced MRI of an Epicardial Scar
Figure 4:
Figure 4:. Epicardial VT and Pace-mapping
Figure 5:
Figure 5:. Voltage Mapping and Intramural Scar
See this image and copyright information in PMC

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