Isolated Potentials and Pace‐Mapping as Guides for Ablation of Ventricular Tachycardia in Various Types of Nonischemic Cardiomyopathy

Kühne, Michael; Abrams, Gerald D.; Sarrazin, J.; Crawford, Thomas; Good, Eric; Chugh, Aman; Ebinger, Matthew; Jongnarangsin, Krit; Pelosi, Frank; Oral, Hakan; Morady, Fred; Bogun, Frank

doi:10.1111/j.1540-8167.2010.01756.x

Cited by 39 publications

(16 citation statements)

References 17 publications

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“…Ouyang et al 24 described the presence of LPs at the epicardial mapping in 4 patients with exercise‐induced VTs in the context of inferolateral aneurysm and normal endocardial substrate. Kuhne et al 25 demonstrated that in patients with nonischemic cardiomyopathy presence of LPs predicted a better outcome after the ablation. Those results were confirmed by Nakahara et al , 11 who proved a more favorable prognosis in patients with an higher density of very LPs.…”

Section: Discussionmentioning

confidence: 99%

Late Potentials Abolition as an Additional Technique for Reduction of Arrhythmia Recurrence in Scar Related Ventricular Tachycardia Ablation

Vergara¹,

Trevisi²,

Ricco³

et al. 2012

Cardiovasc electrophysiol

239

181

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Section: Discussionmentioning

confidence: 99%

Late Potentials Abolition as an Additional Technique for Reduction of Arrhythmia Recurrence in Scar Related Ventricular Tachycardia Ablation

Vergara¹,

Trevisi²,

Ricco³

et al. 2012

Cardiovasc electrophysiol

239

181

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“…Additionally, an ablation strategy targeting LPs was highly successful in the ICM patients (82% freedom from VT at 12 month followup) yet the NICM cohort only had a 50% freedom from VT at 15 months 13 . Consistent with these observations, Kuhne et al 14 also assessed the prevalence of late potentials in patients with NICM undergoing VT ablation and noted a marked improvement in outcomes (67% vs 7% freedom from VT) in patients with late potentials identified versus those without. The differences in late potential characterization seen between the ICM and NICM groups once again highlight the differences in scar biology in patients with NICM and reinforce the notion that current ablation strategies remain suboptimal.…”

Section: Location Of the Arrhythmogenic Substratementioning

confidence: 70%

Advances in Ablation of Ventricular Tachycardia in Nonischemic Cardiomyopathy

2012

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Management of patients with nonischemic cardiomyopathy (NICM) and ventricular tachycardia (VT) remains challenging. The role of catheter ablation for VT continues to evolve for these patients. Prior reports have described the location of the arrhythmogenic substrate for patients with NICM to be frequently located along the basal left ventricle, with an epicardial predilection. Additionally, predictors for identifying whether mapping the endocardium or epicardial surface of the heart have been identified for improved success of VT ablation in this patient population. This chapter will review the latest advances in catheter ablation of ventricular tachycardia in patients with NICM.

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“…31,32 Of note, mapping of abnormal EGMs during RV pacing may be more sensitive than during normal sinus rhythm (NSR) or biventricular pacing due to a change in the direction of the activation wave front (see Figure 1). 33 Following substrate characterisation, VT induction is attempted ( Figure 2).…”

Section: Substrate Characterisationmentioning

confidence: 99%

Ventricular Tachycardia Ablation – The Right Approach for the Right Patient

Sadek¹,

Schaller²,

Supple³

et al. 2014

Arrhythm Electrophysiol Rev

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Scar-related reentrant ventricular tachycardia (VT) may be present in a variety of structural heart disease (SHD) phenotypes. In this setting, VT circuits are comprised of viable myocytes separated by fibrosis, allowing for the slow conduction needed to facilitate reentry.1,2 Aetiologies of fibrosis include ischaemic heart disease (IHD), inflammatory conditions, infiltrative cardiomyopathy, dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy and arrhythmogenic right ventricular (RV) dysplasia.Implantable cardioverter defibrillators (ICDs) are the mainstay of therapy for the prevention of sudden cardiac death in patients with SHD.3 However, ICD shocks are associated with diminished quality of life and increased mortality.4-6 Anti-arrhythmic drugs (AADs) have an important role in shock reduction; however these agents often have limited efficacy and significant side-effects. 7,8 Catheter ablation has assumed an increasingly important role in the management of VT. In patients with IHD and drug-refractory VT, ablation has been shown to reduce arrhythmia recurrence and ICD therapies. 9-11Patients who have VT rendered non-inducible by an ablation procedure have a lower VT recurrence rate and mortality compared with those who still have inducible arrhythmias after the ablation.12 Catheter ablation has also been shown to be effective in the treatment of VT storm in patients with SHD receiving chronic AAD therapy. 13In the setting of non-ischaemic SHD, catheter ablation outcome varies according to the nature of the underlying heart disease, with a greater need for epicardial mapping and ablation, higher recurrence rate and more AAD use in long-term follow-up.14-16 For the most part, VT ablation remains underutilised and some patients may benefit from earlier intervention. 17Although ablation also has an important role in the management of patients with idiopathic VT, this review will focus on ablation of scarrelated reentrant VT, the most common mechanism of monomorphic VT in patients with SHD. Pre-procedural PlanningHeart failure optimisation is important for decreasing the risk of Electrocardiographic CharacterisationTwelve-lead electrocardiograms (ECGs) of all clinical VTs are important in localising VT exit sites, identifying potential ablation targets and directing the best ablation strategy including possible epicardial access.In the setting of non-ischaemic IHD, morphological criteria suggesting Abstract Scar-related reentry is the most common mechanism of monomorphic ventricular tachycardia (VT) in patients with structural heart disease. Catheter ablation has assumed an increasingly important role in the management of VT in this setting, and has been shown to reduce VT recurrence and implantable cardioverter defibrillator (ICD) shocks. The approach to mapping and ablation will depend on the underlying heart disease etiology, VT inducibility and haemodynamic stability. This review explores pre-procedural planning, approach to ablation of both mappable and unmappable VT, and post-procedural testing. Future de...

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Isolated Potentials and Pace‐Mapping as Guides for Ablation of Ventricular Tachycardia in Various Types of Nonischemic Cardiomyopathy

Cited by 39 publications

References 17 publications

Late Potentials Abolition as an Additional Technique for Reduction of Arrhythmia Recurrence in Scar Related Ventricular Tachycardia Ablation

Late Potentials Abolition as an Additional Technique for Reduction of Arrhythmia Recurrence in Scar Related Ventricular Tachycardia Ablation

Advances in Ablation of Ventricular Tachycardia in Nonischemic Cardiomyopathy

Ventricular Tachycardia Ablation – The Right Approach for the Right Patient

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