Ventricular tachycardia ablation: Difference between revisions
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* [[Monomorphic VT]] is a suitable target for [[ablation]]. | * [[Monomorphic VT]] is a suitable target for [[ablation]]. | ||
* Ablation can be used for [[polymorphic VT]] or [[VF]] if an initiating [[PVC]] focus or substrate is accessable. | * Ablation can be used for [[polymorphic VT]] or [[VF]] if an initiating [[PVC]] focus or substrate is accessable. | ||
* | * Mechanism and location of [[ventricular arrhythmia]] may determine The [[ablation]] strategy, risks and outcomes. | ||
* Approach for ablation can be done through a [[transvenous]] for the [[right ventricle]] or [[transaortic]]/[[transeptal]] for the [[left ventricle]]. | * The location of [[ventricular arrhythmia]] maybe subendocardium]] or [[subepicardium]]. | ||
* Approach for ablation can be done through a [[transvenous]] for the [[right ventricle]] or [[transaortic]]/[[transeptal]] for the [[left ventricle]] subendocardium [[ventricular arrhythmia]]. | |||
== Radiofrequency ablation == | == Radiofrequency ablation == | ||
Revision as of 05:45, 5 May 2021
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Ventricular tachycardia Microchapters |
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Differentiating Ventricular Tachycardia from other Disorders |
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Diagnosis |
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Treatment |
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Case Studies |
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Ventricular tachycardia ablation On the Web |
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Risk calculators and risk factors for Ventricular tachycardia ablation |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
Radiofrequency ablation is used for the treatment of ventricular tachycardia in patients with left ventricular dysfunction secondary to previous MI, bundle branch reentry circuits, cardiomyopathy as well as in idiopathic cases.
Catheter ablation
- Catheter ablation is useful for treating ventricular arrhythmia when drugs are ineffective.
- Monomorphic VT is a suitable target for ablation.
- Ablation can be used for polymorphic VT or VF if an initiating PVC focus or substrate is accessable.
- Mechanism and location of ventricular arrhythmia may determine The ablation strategy, risks and outcomes.
- The location of ventricular arrhythmia maybe subendocardium]] or subepicardium.
- Approach for ablation can be done through a transvenous for the right ventricle or transaortic/transeptal for the left ventricle subendocardium ventricular arrhythmia.
Radiofrequency ablation
- Radiofrequency ablation is used for the treatment of ventricular tachycardia in patients with left ventricular dysfunction secondary to previous MI, bundle branch reentry circuits, cardiomyopathy as well as in idiopathic cases.[1]
2006 ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT) [1]
Ablation (DO NOT EDIT) [1]
| Class I |
| "1. Ablation is indicated in patients who are otherwise at low risk for SCD and have sustained predominantly monomorphic VT that is drug resistant, who are drug intolerant, or who do not wish long-term drug therapy. (Level of Evidence: C) " |
| "2. Ablation is indicated in patients with bundle branch reentrant VT. (Level of Evidence: C) " |
| "3. Ablation is indicated as adjunctive therapy in patients with an ICD who are receiving multiple shocks as a result of sustained VT that is not manageable by reprogramming or changing drug therapy or who do not wish long-term drug therapy. (Level of Evidence: C)[2][3] " |
| "4. Ablation is indicated in patients with Wolff-Parkinson-White syndrome resuscitated from sudden cardiac arrest due to atrial fibrillation and rapid conduction over the accessory pathway causing VF. (Level of Evidence: B)[4] " |
| Class III |
| "1. Ablation of asymptomatic relatively infrequent PVCs is not indicated. (Level of Evidence: C)" |
| Class IIa |
| "1. Ablation can be useful therapy in patients who are otherwise at low risk for SCD and have symptomatic nonsustained monomorphic VT that is drug resistant, who are drug intolerant or who do not wish long-term drug therapy.(Level of Evidence: C)" |
| " 2. Ablation can be useful therapy in patients who are otherwise at low risk for SCD and have frequent symptomatic predominantly monomorphic PVCs that are drug resistant or who are drug intolerant or who do not wish long-term drug therapy.(Level of Evidence: C)" |
| " 3. Ablation can be useful in symptomatic patients with Wolff-Parkinson-White syndrome who have accessory pathways with refractory periods less than 240 ms in duration. (Level of Evidence: B)[4]" |
| Class IIb |
| 1. "Ablation of Purkinje fiber potentials may be considered in patients with ventricular arrhythmia storm consistently provoked by PVCs of similar morphology. (Level of Evidence: C)[5]" |
| 2. "Ablation of asymptomatic PVCs may be considered when the PVCs are very frequent to avoid or treat tachycardia-induced cardiomyopathy. (Level of Evidence: C)[6]" |
References
- ↑ 1.0 1.1 1.2 Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M; et al. (2006). "ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". Circulation. 114 (10): e385–484. doi:10.1161/CIRCULATIONAHA.106.178233. PMID 16935995.
- ↑ Bhandari AK, Shapiro WA, Morady F, Shen EN, Mason J, Scheinman MM (1985). "Electrophysiologic testing in patients with the long QT syndrome". Circulation. 71 (1): 63–71. PMID 2856866.
- ↑ Silva RM, Mont L, Nava S, Rojel U, Matas M, Brugada J (2004). "Radiofrequency catheter ablation for arrhythmic storm in patients with an implantable cardioverter defibrillator". Pacing Clin Electrophysiol. 27 (7): 971–5. doi:10.1111/j.1540-8159.2004.00567.x. PMID 15271018.
- ↑ 4.0 4.1 {{cite journal| author=Pappone C, Santinelli V, Manguso F, Augello G, Santinelli O, Vicedomini G et al.| title=A randomized study of prophylactic catheter ablation in asymptomatic patients with the Wolff-Parkinson-White syndrome. | journal=N Engl J Med | year= 2003 | volume= 349 | issue= 19 | pages= 1803-11 | pmid=14602878 | doi=10.1056/NEJMoa035345 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14602878
- ↑ Haïssaguerre M, Shoda M, Jaïs P, Nogami A, Shah DC, Kautzner J; et al. (2002). "Mapping and ablation of idiopathic ventricular fibrillation". Circulation. 106 (8): 962–7. PMID 12186801.
- ↑ Takemoto M, Yoshimura H, Ohba Y, Matsumoto Y, Yamamoto U, Mohri M; et al. (2005). "Radiofrequency catheter ablation of premature ventricular complexes from right ventricular outflow tract improves left ventricular dilation and clinical status in patients without structural heart disease". J Am Coll Cardiol. 45 (8): 1259–65. doi:10.1016/j.jacc.2004.12.073. PMID 15837259.