Recent advances in ablation of ventricular tachycardia associated with structural heart disease

Proietti, Riccardo; Roux, Jean‐François; Essebag, Vidal

doi:10.1097/hco.0000000000000242

Cited by 13 publications

(10 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, novel ablation strategies, such as LAVA elimination, dechannelling, substrate isolation or scar homogenisation, might have resulted in a better outcome and a lower mortality rate. [25–31]…”

Section: Discussionmentioning

confidence: 99%

Preventive Ventricular Tachycardia Ablation in Patients with Ischaemic Cardiomyopathy: Meta-analysis of Randomised Trials

Tilz¹,

Eitel²,

Lyan³

et al. 2019

Arrhythm Electrophysiol Rev

Self Cite

View full text Add to dashboard Cite

Catheter ablation of ventricular tachycardia (VT) aims to treat the underlying arrhythmia substrate to prevent ICD therapies. The aim of this meta-analysis was to assess the safety and efficacy of VT ablation prior to or at the time of secondary prevention ICD implantation in patients with coronary artery disease, as compared with deferred VT ablation. Based on a systematic literature search, three randomised trials were considered eligible for inclusion in this analysis, and data on the number of patients with appropriate ICD shocks, appropriate ICD therapy, arrhythmic storm, death and major complications were extracted from each study. On pooled analysis, there was a significant reduction of appropriate ICD shocks (OR 2.58; 95% CI [1.54–4.34]; p<0.001) and appropriate ICD therapies (OR 2.04; 95% CI [1.15–3.61]; p=0.015) in patients undergoing VT ablation at the time of ICD implantation without significant differences with respect to complications (OR 1.39; 95% CI [0.43–4.51]; p=0.581). Mortality did not differ between both groups (OR 1.30; 95% CI [0.60–2.45]; p=0.422). Preventive catheter ablation of VT in patients with coronary heart disease at the time of secondary prevention ICD implantation results in a significant reduction of appropriate ICD shocks and any appropriate ICD therapy compared with patients without or with deferred VT ablation. No significant difference with respect to complications or mortality was observed between both treatment strategies.

show abstract

Section: Discussionmentioning

confidence: 99%

Preventive Ventricular Tachycardia Ablation in Patients with Ischaemic Cardiomyopathy: Meta-analysis of Randomised Trials

Tilz¹,

Eitel²,

Lyan³

et al. 2019

Arrhythm Electrophysiol Rev

Self Cite

View full text Add to dashboard Cite

show abstract

“…Accordingly, a wide range of substrate ablation strategies have been developed over the years from scar homogenization to scar dechanneling or core isolation. Many of these topics have been the focus of a number of prior reviews, some published by our group 15,16 …”

Section: Introductionmentioning

confidence: 99%

“…This enables an increase in the near‐field voltage detected and reduces far‐field signals providing a better definition of substrate. Furthermore, omnipolar mapping catheters also provide a wavefront directional assessment 15 . This is advantageous in a structure like myocardial scar in which wavefront depolarization rapidly changes direction.…”

Section: Introductionmentioning

confidence: 99%

The challenge of optimising ablation lesions in catheter ablation of ventricular tachycardia

Proietti

Lichelli

Lellouche

et al. 2020

Journal of Arrhythmia

Self Cite

View full text Add to dashboard Cite

Over the last decade, radiofrequency catheter ablation (RFCA) has become an established treatment for ventricular arrhythmias (VA). The recent international consensus report supports RFCA as a first-line therapy for VA in normal heart Ventricular Tachycardia (VT) and in structural heart VT after ineffective anti-arrhythmic drug (AAD) therapy. 1 Several groups have taken this further, proposing prophylactic VT ablation before implantable cardiac defibrillator (ICD) insertion; however this remains an area of debate. 2 Though

show abstract

“…The ablation strategy for ventricular tachycardia (VT) in patients with structural heart disease has rapidly evolved from an entrainment mapping approach for identification of the critical isthmus of the re‐entrant circuit during monomorphic VT, toward a substrate‐based approach aiming to ablate surrogate markers of the circuit during sinus rhythm in hemodynamically nontolerated and polymorphic VT . More recently, off‐line analyses of substrate mapping to identify the footprints of VT circuits in sinus rhythm have been proposed …”

Section: Introductionmentioning

confidence: 99%

A Historical Perspective on the Role of Functional Lines of Block in the Re‐entrant Circuit of Ventricular Tachycardia

Proietti

Roux

AlTurki

et al. 2016

Pacing Clinical Electrophis

Self Cite

View full text Add to dashboard Cite

The ablation strategy for ventricular tachycardia (VT) rapidly evolved from an entrainment mapping approach for identification of the critical isthmus of the re-entrant circuit during monomorphic VT, toward a substrate-based approach aiming to ablate surrogate markers of the circuit during sinus rhythm in hemodynamically nontolerated and polymorphic VT. The latter approach implies an assumption that the circuits responsible for the arrhythmia are anatomical or fixed, and present during sinus rhythm. Accordingly, the lines of block delimiting the channels of the circuits are often considered fixed, although there is evidence that they are functional or more frequently a combination of fixed and functional. The electroanatomical substrate-based approach to VT ablation performed during sinus rhythm is increasingly adopted in clinical practice and often described as scar homogenization, scar dechanneling, or core isolation. However, whether the surrogate markers of the VT circuit during sinus rhythm match the circuit during arrhythmias remains to be fully demonstrated. The myocardial scar is a heterogeneous electrophysiological milieu with complex arrhythmogenic mechanisms that potentially coexist simultaneously. Moreover, the scar consists of different areas of diverse refractoriness and conduction. It can be misleading to limit the arrhythmogenic perspective of the myocardial scar to fixed or anatomical barriers held responsible for the re-entry circuit. Greater understanding of the role of functional lines of block in VT and the validity of the surrogate targets being ablated is necessary to further improve the technique and outcome of VT ablation.

show abstract

Recent advances in ablation of ventricular tachycardia associated with structural heart disease

Cited by 13 publications

References 29 publications

Preventive Ventricular Tachycardia Ablation in Patients with Ischaemic Cardiomyopathy: Meta-analysis of Randomised Trials

Preventive Ventricular Tachycardia Ablation in Patients with Ischaemic Cardiomyopathy: Meta-analysis of Randomised Trials

The challenge of optimising ablation lesions in catheter ablation of ventricular tachycardia

A Historical Perspective on the Role of Functional Lines of Block in the Re‐entrant Circuit of Ventricular Tachycardia

Contact Info

Product

Resources

About