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Review
. 2023 Aug 14:10:966634.
doi: 10.3389/fcvm.2023.966634. eCollection 2023.

Catheter ablation of ventricular tachycardia: strategies to improve outcomes

Muthiah Subramanian #  1 , Auras R Atreya #  2 , Daljeet Kaur Saggu  1 , Sachin Yalagudri  1 , Narasimhan Calambur  1
Affiliations
Review

Catheter ablation of ventricular tachycardia: strategies to improve outcomes

Muthiah Subramanian et al. Front Cardiovasc Med. .

Abstract

Catheter ablation of ventricular arrhythmias has evolved considerably since it was first described more than 3 decades ago. Advancements in understanding the underlying substrate, utilizing pre-procedural imaging, and evolving ablation techniques have improved the outcomes of catheter ablation. Ensuring safety and efficacy during catheter ablation requires adequate planning, including analysis of the 12 lead ECG and appropriate pre-procedural imaging. Defining the underlying arrhythmogenic substrate and disease eitology allow for the developed of tailored ablation strategies, especially for patients with non-ischemic cardiomyopathies. During ablation, the type of anesthesia can affect VT induction, the quality of the electro-anatomic map, and the stability of the catheter during ablation. For high risk patients, appropriate selection of hemodynamic support can increase the success of VT ablation. For patients in whom VT is hemodynamically unstable or difficult to induce, substrate modification strategies can aid in safe and successful ablation. Recently, there has been an several advancements in substrate mapping strategies that can be used to identify and differentiate local late potentials. The incorporation of high-definition mapping and contact-sense technologies have both had incremental benefits on the success of ablation procedures. It is crucial to harness newer technology and ablation strategies with the highest level of peri-procedural safety to achieve optimal long-term outcomes in patients undergoing VT ablation.

Keywords: catheter ablation; electro-anatomic mapping; improving VT ablation; substrate mapping; ventricular tachycardia.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Utility of Pre-procedural imaging. Three dimensional volume rendered CT image of heart showing submitral posterobasal aneurysm (green dots) (A). 3D Electroanatomic Images in RAO and PA showing earliest activation in the aneurysm (white arrow) (B). RFA at this site eliminated the PVCs.
Figure 2
Figure 2
Importance of multielectrode mapping. A Case of ARVC with VT storm: substrate mapping with (A) multipolar catheter (1 mm electrode size) showed isolated late potentials within the scar; (B) mapping with the ablation catheter (3.5 mm tip electrode) at the same site could not pick up these signals. However, pacing at same site captured with latency.
Figure 3
Figure 3
Bipolar ablation for intramural substrate. A case of cardiac sarcoidosis with an intramural substrate. Bipolar ablation was delivered through an endocardial and epicardial catheter at the basal lateral wall. The distance between the tips of the ablation catheters was 10 mm. There was termination of the tachycardia during ablation.
Figure 4
Figure 4
Summary of approach to VT ablation in patients with and without structural heart disease.
See this image and copyright information in PMC

References

    1. Stevenson WG, Wilber DJ, Natale A, Jackman WM, Marchlinski FE, Talbert T, et al. Irrigated radiofrequency catheter ablation guided by electroanatomic mapping for recurrent ventricular tachycardia after myocardial infarction: the multicenter thermocool ventricular tachycardia ablation trial. Circulation. (2008) 118:2773–82. 10.1161/CIRCULATIONAHA.108.788604 - DOI - PubMed
    1. Reddy VY, Reynolds MR, Neuzil P, Richardson AW, Taborsky M, Jongnarangsin K, et al. Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med. (2007) 357:2657–65. 10.1056/NEJMoa065457 - DOI - PMC - PubMed
    1. Hutchinson MD, Gerstenfeld EP, Desjardins B, Bala R, Riley MP, Garcia FC, et al. Endocardial unipolar voltage mapping to detect epicardial ventricular tachycardia substrate in patients with nonischemic left ventricular cardiomyopathy. Circ Arrhythm Electrophysiol. (2011) 4:49–55. 10.1161/CIRCEP.110.959957 - DOI - PMC - PubMed
    1. Desjardins B, Yokokawa M, Good E, Crawford T, Latchamsetty R, Jongnarangsin K, et al. Characteristics of intramural scar in patients with nonischemic cardiomyopathy and relation to intramural ventricular arrhythmias. Circ Arrhythm Electrophysiol. (2013) 6:891–7. 10.1161/CIRCEP.113.000073 - DOI - PubMed
    1. Sanchez JM, Yuan C, Hsia HH. Optimal ablation techniques for ventricular tachycardia management. J Innov Card Rhythm Manag. (2018) 9:2969–81. 10.19102/icrm.2018.090101 - DOI - PMC - PubMed

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