Infarct transmurality as a criterion for first-line endo-epicardial substrate–guided ventricular tachycardia ablation in ischemic cardiomyopathy

Abstract

The endocardial approach in patients with transmural MI undergoing VT substrate ablation is associated with an increased risk of recurrence. IT may be a useful criterion for the selection of a first-line combined endo-epicardial approach.

Late potentials abolition reduces ventricular tachycardia recurrence after ablation especially in higher‐risk patients with a chronic total occlusion in an infarct‐related artery

“…We found epicardial LP in the majority of patients with IRA‐CTO that underwent epicardial mapping. In another study, endoepicardial mapping and ablation was found to be superior to an endocardial‐only approach in patients with transmural MI . Unfortunately, detailed information about the transmurality of the MI was not available for the majority of patients in our study.…”

“…In another study, endoepicardial mapping and ablation was found to be superior to an endocardial-only approach in patients with transmural MI. 19 Unfortunately, detailed information about the transmurality of the MI was not available for the majority of patients in our study. However, it is highly proba- On the other hand, LP cannot always be abolished, possibly due also to limitations of radiofrequency as an energy source; contact force information and other newer ablation techniques might improve these results.…”

Clinical impact of cardiovascular magnetic resonance with optimized myocardial scar detection in patients with cardiac implantable devices

“…[23] Probably the greatest clinical impact was related to electrophysiology procedural decisionmaking in patients with VT. Detecting thrombus and localizing ischemic versus nonischemic scar had substantial impact on planned ablation approaches (endocardial vs epicardial and left vs right ventricular), in accordance with previously-published data. [8] In patients with pacemakers, scar assessment guided decisions regarding immunosuppression or device upgrade in sarcoidosis and genetic screening in patients with suspected cardiomyopathy. Across all CIEDs, new diagnoses (principally unexpected myocardial infarction or cardiomyopathies) were made in almost one in five patients.…”

“…[1] This has led to an increase in demand for CMR [2] to determine the aetiology of heart failure, [3] assess viability, [4,5] prognosis, [6,7] and guide both coronary and electrophysiological interventions. [8] Alongside this rise in CMR, indications for cardiac implantable electronic devices (CIEDs) including permanent pacemakers (PPM) and implantable cardioverter defibrillators (ICD) are expanding, meaning that there are now 2.9 million people in the US alone with CIEDs. [9,10] Many of these patients with electrical abnormalities also have structural cardiac abnormalities, with LGE CMR clinically indicated to accurately assess scar to aid diagnosis and plan electrophysiological procedures.…”

“…[9,10] Many of these patients with electrical abnormalities also have structural cardiac abnormalities, with LGE CMR clinically indicated to accurately assess scar to aid diagnosis and plan electrophysiological procedures. [8] Historically, MRI has been contraindicated in patients with CIEDs due to safety concerns. However, MRI-conditional CIEDs have been developed and are industry standard.…”