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.
Highlights
1.2 Methods1.1 Document scope and rationaleThe field of electrophysiology has undergone rapid progress in the last decade, with advances both in our understanding of the genesis of ventricular arrhythmias (VAs) and in the technology used to treat them
ECG tracings provide important insights regarding location of either the source of focal arrhythmias or the exit site for reentrant ventricular tachycardia (VT); when possible, a 12-lead ECG should be obtained of the target VA(s) (PVC or VT) and be used as a guide for where to concentrate mapping efforts based on published algorithms
No randomized studies have demonstrated the benefit of intraprocedural imaging, there are data supporting the use of coronary angiography or intracardiac echocardiography (ICE) to enhance procedural safety for selected cases, allowing for real-time imaging while mapping and ablation are performed [60, 86, 171, 172, 244, 262, 263, 265, 276, 461, 556, 689,690,691,692,693,694,695,696,697]
Summary
The field of electrophysiology has undergone rapid progress in the last decade, with advances both in our understanding of the genesis of ventricular arrhythmias (VAs) and in the technology used to treat them. LOE A is derived from highquality randomized controlled trials (RCTs); LOE B-R is derived from moderate-quality RCTs; LOE B-NR is derived from well-designed nonrandomized studies; LOE C-LD is derived from randomized or nonrandomized studies with limitations of design or execution; and LOE C-EO indicates that a recommendation was based on expert opinion [7] Unique to this consensus statement is the systematic review commissioned for this document as part of HRS’s efforts to adopt the rigorous methodology required for guideline development. Of public comment, and the entire document underwent rigorous peer review by each of the participating societies and revision by the Chairs, before endorsement
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