2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias

Abstract

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

Detection of concealed structural heart disease by imaging in patients with apparently idiopathic premature ventricular complexes: A review of current literature

“…40 The recent 2019 HRS/EHRA/APHRS/LAHRS Expert Consensus on CA of VAs, recommends CA of idiopathic PVCs in patients with symptomatic PVCs originating from RVOT as first line therapeutic approach in preference to AAD therapy. 41 In patients with symptomatic PVCs originating from other sites than RVOT (including LVOT, epicardial OT or LV summit) or in those presenting with polymorphic PVCs, CA can be considered only after failed/not tolerated medical therapy or when patients refuse taking drugs. 41 Owing to the benign nature of truly idiopathic PVCs, implantable cardiac defibrillators are not recommended.…”

“…41 In patients with symptomatic PVCs originating from other sites than RVOT (including LVOT, epicardial OT or LV summit) or in those presenting with polymorphic PVCs, CA can be considered only after failed/not tolerated medical therapy or when patients refuse taking drugs. 41 Owing to the benign nature of truly idiopathic PVCs, implantable cardiac defibrillators are not recommended. However, it should be considered in patients with persistent LV dysfunction after a reasonable waiting period of 4-6 months following efficacious AAD or ablative treatment, according to the current guideline recommendations for primary prevention of SCD in heart failure.…”

Electrocardiographic characteristics of idiopathic ventricular arrhythmias based on anatomy

“…In patients with symptomatic, idiopathic, sustained monomorphic VT, catheter ablation might be preferable to medical therapy. It is a more definitive treatment option, given its high success and low recurrence rate (Cronin et al, 2019;Krittayaphong et al, 2006;Miyazawa et al, 2017).…”

The year in cardiology: arrhythmias and pacing

“…CA of ventricular arrhythmia (VA) guideline suggests that programmed electrical stimulation may come back into fashion as a method for prognostic prediction, this time in patients with frequent PVCs and structural heart disease, and also recommends use of ICE for VA ablation although much of the world does not use ICE without any apparent compromise to their outcomes. 71 The sex differences in arrhythmia consensus highlighted that although outcomes may be different, this should not influence provision of CA for females. 72…”