31 - Ablation of Ventricular Tachycardia Associated With Nonischemic Cardiomyopathy

Abstract

Ventricular tachycardia (VT) is an outcome-defining complication in the natural history of non-ischemic cardiomyopathies, including idiopathic dilated cardiomyopathy, cardiac sarcoidosis, arrhythmogenic right ventricular cardiomyopathy, among others. While a number of scar-based approaches towards mapping and ablation can be utilized, the ablative treatment of VT in these patients can be challenging. It commonly requires combined endocardial and epicardial mapping/ablation, and is associated with high rates of incomplete success, long-term arrhythmia recurrences and need for multiple procedures. This is largely due to the fact that the arrhythmogenic substrate is frequently intramural and/or epicardial. Therefore, accurate characterization of the substrate with pre-procedural imaging can help optimize procedural planning, including determining the need for epicardial mapping. In this chapter we discuss diagnostic criteria, characterization of the arrhythmogenic substrate, pre-procedural planning, ablation approaches and end points, and disease-specific considerations.