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Review
. 2018 Jul 26;10(7):52-59.
doi: 10.4330/wjc.v10.i7.52.

Novel approaches for the treatment of ventricular tachycardia

Michael Spartalis  1 , Eleftherios Spartalis  2 , Eleni Tzatzaki  3 , Diamantis I Tsilimigras  2 , Demetrios Moris  4 , Christos Kontogiannis  5 , Efthimios Livanis  3 , Dimitrios C Iliopoulos  2 , Vassilis Voudris  3 , George N Theodorakis  3
Affiliations
Review

Novel approaches for the treatment of ventricular tachycardia

Michael Spartalis et al. World J Cardiol. .

Abstract

Ventricular tachycardia (VT) is a crucial cause of sudden cardiac death (SCD) and a primary cause of mortality and morbidity in patients with structural cardiac disease. VT includes clinical disorders varying from benign to life-threatening. Most life-threatening episodes are correlated with coronary artery disease, but the risk of SCD varies in certain populations, with various underlying heart conditions, specific family history, and genetic variants. The targets of VT management are symptom alleviation, improved quality of life, reduced implantable cardioverter defibrillator shocks, prevention of reduction of left ventricular function, reduced risk of SCD, and improved overall survival. Antiarrhythmic drug therapy and endocardial catheter ablation remains the cornerstone of guideline-endorsed VT treatment strategies in patients with structural cardiac abnormalities. Novel strategies such as epicardial ablation, surgical cryoablation, transcoronary alcohol ablation, pre-procedural imaging, and stereotactic ablative radiotherapy are an appealing area of research. In this review, we gathered all recent advances in innovative therapies as well as experimental evidence focusing on different aspects of VT treatment that could be significant for future favorable clinical applications.

Keywords: Catheter ablation; Epicardial; Novel techniques; Substrate; Sudden cardiac death; Ventricular tachycardia.

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Conflict of interest statement

Conflict-of-interest statement: No potential conflicts of interest. No financial support.

Figures

Figure 1
Figure 1
Arrhythmia substrate is deep (blue arrow), but the radiofrequency ablation lesions are not that deep. RF: Radiofrequency.
Figure 2
Figure 2
Endocardial and epicardial voltage mapping. A: The voltage map of the endocardium shows an area of scar. The map is color-coded to represent bipolar electro-gram voltage (red: Dense scar, 0.5 mV; purple: Normal tissue, 1.5 mV, intervening colors represent voltage values in between); B: The voltage map of the epicardium shows a larger area of scar.
Figure 3
Figure 3
Transcoronary alcohol ablation. Coronary angiography of the left anterior descending artery shows a septal perforator with a course to the site of earliest activity. A balloon catheter occludes this branch and ethanol is infused (blue arrows). The ablation catheter is placed at the region of earliest activity (red circle).
Figure 4
Figure 4
Bipolar ablation. Bipolar radiofrequency ablation between the right and left ventricular septum using two catheters.
See this image and copyright information in PMC

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