Catheter Ablation of Ventricular Tachycardia in Ischaemic and Non-Ischaemic Cardiomyopathy: Where Are We Today? A Clinical Review

Perspective:

The following are 10 points to remember from this review of catheter ablation of ventricular tachycardia (VT) in patients with structural heart disease (SHD):

1. Most patients with SHD and monomorphic VT have ventricular scar caused by prior infarction in patients with ischemic cardiomyopathy (ICM) or fibrosis in patients with nonischemic cardiomyopathy (NICM).

2. Because nonclinical VTs often are inducible in patients with VT, a 12-lead electrocardiogram of the spontaneous VT is very helpful for identifying clinical VTs in the electrophysiology laboratory.

3. In patients with an implantable cardioverter-defibrillator, the morphology of the stored electrograms of an episode of VT can be a useful template for recognizing clinical VTs in the electrophysiology laboratory.

4. Epicardial ablation is more likely to be necessary in patients with NICM and arrhythmogenic right ventricular cardiomyopathy/dysplasia than in patients with ICM.

5. Activation mapping and entrainment mapping are useful for identifying critical sites for ablation of VTs that are hemodynamically tolerated.

6. When VT is not tolerated, a combination of scar mapping and pace mapping can be used to identify ablation sites.

7. The rate of procedure-related death is reported to be 0-3%, with the most common cause of death being uncontrolled VT.

8. The most common complications are stroke, cardiac tamponade, valve injury, and atrioventricular block.

9. The rate of recurrent VT post-ablation is reported to be 25-50%.

10. There is no evidence that catheter ablation of VT improves survival.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Pericardial Disease, Implantable Devices, EP Basic Science, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Stroke, Infarction, Electrocardiography, Arrhythmogenic Right Ventricular Dysplasia, Atrioventricular Block, Electrophysiology, Cause of Death, Tachycardia, Ventricular, Cicatrix, Cardiomyopathies, Catheter Ablation, Defibrillators, Implantable, Cardiac Tamponade


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