Abstract
Despite the technical improvements made in recent years, the overall long‐term success rate of ventricular tachycardia (VT) ablation in patients with ischemic cardiomyopathy remains disappointing. This unsatisfactory situation has persisted even though several approaches to VT substrate ablation allow mapping and ablation of noninducible/nontolerated arrhythmias. The current substrate mapping methods present some shortcomings regarding the accurate definition of the true scar, the modality of detection in sinus rhythm of abnormal electrograms that identify sites of critical channels during VT and the possibility to determine the boundaries of functional re‐entrant circuits during sinus or paced rhythms. In this review, we focus on current and proposed ablation strategies for VT to provide an overview of the potential/real application (and results) of several ablation approaches and future perspectives.
Highlights
Radiofrequency catheter ablation is an effective treatment for drugrefractory ventricular tachycardias (VTs) in patients with ischemic cardiomyopathy.[1]
Despite the technical improvements made in recent years, the overall long-term success rate of ventricular tachycardia (VT) ablation in patients with ischemic cardiomyopathy remains disappointing
The current substrate mapping methods present some shortcomings regarding the accurate definition of the true scar, the modality of detection in sinus rhythm of abnormal electrograms that identify sites of critical channels during VT and the possibility to determine the boundaries of functional re-entrant circuits during sinus or paced rhythms
Summary
Radiofrequency catheter ablation is an effective treatment for drugrefractory ventricular tachycardias (VTs) in patients with ischemic cardiomyopathy.[1]. If a re-entrant VT is reproducible and hemodynamically tolerated, activation and/or entrainment mapping can be used to identify a critical re-entry isthmus and ablate the VT. If VTs are not inducible or not hemodynamically tolerated, ablation can be guided by identifying the VT substrate during sinus rhythm or a paced rhythm.[3] Substratebased approaches involve identifying low-voltage areas and abnormal electrograms that represent surviving myocytes capable of supporting re-entrant VT circuits.[4] Comparing if substrate-based ablation strategy to one guided predominantly by activation/entrainment mapping of inducible and hemodynamically tolerated VTs the results have been variable.[5] recent studies seem to suggest that substratebased ablation is superior to the ablation of clinical hemodynamically stable VT, even in patients with only tolerated (clinical and/or induced) VTs.[6,7,8]
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