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Erschienen in: Herzschrittmachertherapie + Elektrophysiologie 1/2022

14.02.2022 | Ablationstherapie | Schwerpunkt

Update Ablation ventrikulärer Tachyarrhythmien

verfasst von: Shibu Mathew, Dr. med. Patrick Müller, Carina Hardy, Mauricio Ibrahim Scanavacca, Thomas Deneke

Erschienen in: Herzschrittmachertherapie + Elektrophysiologie | Ausgabe 1/2022

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Zusammenfassung

Die Katheterablation ventrikulärer Tachykardien (VT) wird zunehmend häufiger im klinischen Alltag eingesetzt. Bei der Katheterablation idiopathischer VT zeigen Ergebnisse aus spezialisierten Zentren eine hohe Effektivität. Die Katheterablation bei struktureller Herzerkrankung mit überwiegend narbenassoziierten Reentry-Mechanismen kann insbesondere bei tief liegenden intramyokardialen oder epikardialen Anteilen eine Herausforderung darstellen. Die Integration moderner kardialer Schnittbildgebungsverfahren, neue funktionelle Mappingverfahren und Kathetertechnologien ermöglichen eine optimierte Identifizierung und Charakterisierung des kritischen arrhythmogenen Substrats und eine entsprechend gezieltere Katheterablation von VT. Inwiefern diese Innovationen das Potenzial entfalten werden, die Erfolgsraten der VT-Ablation zu verbessern, werden zukünftige Studien zeigen.
Literatur
2.
Zurück zum Zitat Priori SG et al (2015) 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Europace 17:1601–1687PubMed Priori SG et al (2015) 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Europace 17:1601–1687PubMed
3.
Zurück zum Zitat Eckardt L et al (2018) Updated survey on interventional electrophysiology. 5‑year followup of infrastructure, procedures and training positions in Germany. J Am Coll Cardiol 4:820–827 Eckardt L et al (2018) Updated survey on interventional electrophysiology. 5‑year followup of infrastructure, procedures and training positions in Germany. J Am Coll Cardiol 4:820–827
4.
Zurück zum Zitat Stevenson WG et al (1993) Identification of reentry circuit sites during catheter mapping and radiofrequency ablation of ventricular tachycardia late after myocardial infarction. Circulation 88:1647–1670PubMed Stevenson WG et al (1993) Identification of reentry circuit sites during catheter mapping and radiofrequency ablation of ventricular tachycardia late after myocardial infarction. Circulation 88:1647–1670PubMed
5.
Zurück zum Zitat Stevenson WG et al (1997) Exploring postinfarction reentrant ventricular tachycardia with entrainment mapping. J Am Coll Cardiol 29:1180–1189PubMed Stevenson WG et al (1997) Exploring postinfarction reentrant ventricular tachycardia with entrainment mapping. J Am Coll Cardiol 29:1180–1189PubMed
6.
Zurück zum Zitat Tung R et al (2017) Challenges and pitfalls of entrainment mapping of ventricular tachycardia: ten illustrative concepts. Circ Arrhythm Electrophysiol 10:e4560PubMed Tung R et al (2017) Challenges and pitfalls of entrainment mapping of ventricular tachycardia: ten illustrative concepts. Circ Arrhythm Electrophysiol 10:e4560PubMed
7.
Zurück zum Zitat Gökog IY et al (2016) Scar homogenization versus limited-substrate ablation in patients with nonischemic cardiomyopathy and ventricular tachycardia. J Am Coll Cardiol 68:1990–1998 Gökog IY et al (2016) Scar homogenization versus limited-substrate ablation in patients with nonischemic cardiomyopathy and ventricular tachycardia. J Am Coll Cardiol 68:1990–1998
8.
Zurück zum Zitat al Jaïs Pet (2012) Elimination of local abnormal ventricular activities: a new end point for substrate modification in patient with scar-related ventricular tachycardia. Circulation 125:2184–2196 al Jaïs Pet (2012) Elimination of local abnormal ventricular activities: a new end point for substrate modification in patient with scar-related ventricular tachycardia. Circulation 125:2184–2196
9.
Zurück zum Zitat Tzou WS et al (2015) Core isolation of critical arrhythmia elements for treatment of multiple scar-based ventricular tachycardias. Circ Arrhythm Electrophysiol 8:353–361PubMed Tzou WS et al (2015) Core isolation of critical arrhythmia elements for treatment of multiple scar-based ventricular tachycardias. Circ Arrhythm Electrophysiol 8:353–361PubMed
10.
Zurück zum Zitat Berruezo A et al (2015) Scar dechanneling: new method for scar-related left ventricular tachycardia substrate ablation. Circ Arrhythm Electrophysiol 8:326–336PubMed Berruezo A et al (2015) Scar dechanneling: new method for scar-related left ventricular tachycardia substrate ablation. Circ Arrhythm Electrophysiol 8:326–336PubMed
11.
Zurück zum Zitat Reddy VY et al (2007) Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med 357:2657–2665PubMedPubMedCentral Reddy VY et al (2007) Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med 357:2657–2665PubMedPubMedCentral
12.
Zurück zum Zitat Kuck K‑H et al (2010) Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients withcoronary heart disease (VTACH): a multicentre randomised controlled trial. Lancet 375:31–40PubMed Kuck K‑H et al (2010) Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients withcoronary heart disease (VTACH): a multicentre randomised controlled trial. Lancet 375:31–40PubMed
13.
Zurück zum Zitat Al-Khatib SM et al (2015) Catheter ablation for ventricular tachycardia in patients with an implantable cardioverter defibrillator (CALYPSO) pilot trial. J Cardiovasc Electrophysiol 26:151–157PubMed Al-Khatib SM et al (2015) Catheter ablation for ventricular tachycardia in patients with an implantable cardioverter defibrillator (CALYPSO) pilot trial. J Cardiovasc Electrophysiol 26:151–157PubMed
14.
Zurück zum Zitat Sapp JL et al (2016) Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs. N Engl J Med 375:111–121PubMed Sapp JL et al (2016) Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs. N Engl J Med 375:111–121PubMed
15.
Zurück zum Zitat Kuck HK et al (2017) Impact of substrate modification by catheter ablation on implantable cardioverter-defibrillator interventions inpatients with unstable ventricular arrhythmias and coronary artery disease: results from the multicenter randomized controlled SMS (substrate modification study). Circ Arrhythm Electrophysiol 10(3):e4422PubMed Kuck HK et al (2017) Impact of substrate modification by catheter ablation on implantable cardioverter-defibrillator interventions inpatients with unstable ventricular arrhythmias and coronary artery disease: results from the multicenter randomized controlled SMS (substrate modification study). Circ Arrhythm Electrophysiol 10(3):e4422PubMed
16.
Zurück zum Zitat Martinez BK et al (2019) Systematic review and meta-analysis of catheter ablation of ventricular tachycardia in ischemic heart disease. Heart Rhythm 1:e206–e219 Martinez BK et al (2019) Systematic review and meta-analysis of catheter ablation of ventricular tachycardia in ischemic heart disease. Heart Rhythm 1:e206–e219
17.
Zurück zum Zitat Anderson RD et al (2019) Catheter ablation versus medical therapy for treatment of ventricular tachycardia associated with structural heart disease: systematic review and meta-analysis of randomized controlled trials and comparison with observational studies. Heart Ryhthm 16:1484–1491 Anderson RD et al (2019) Catheter ablation versus medical therapy for treatment of ventricular tachycardia associated with structural heart disease: systematic review and meta-analysis of randomized controlled trials and comparison with observational studies. Heart Ryhthm 16:1484–1491
18.
Zurück zum Zitat Tung R et al (2015) Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: an international VT ablation center collaborative group study. Heart Rhythm 12(9):1997–2007PubMedPubMedCentral Tung R et al (2015) Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: an international VT ablation center collaborative group study. Heart Rhythm 12(9):1997–2007PubMedPubMedCentral
19.
Zurück zum Zitat Willems S et al (2020) Preventive or deferred ablation of ventricular tachycardia in patients with Ischemic cardiomyopathy and implantable defibrillator (BERLIN VT). Circulation 141:1057–1067PubMed Willems S et al (2020) Preventive or deferred ablation of ventricular tachycardia in patients with Ischemic cardiomyopathy and implantable defibrillator (BERLIN VT). Circulation 141:1057–1067PubMed
20.
Zurück zum Zitat Muser D et al (2016) Longterm outcome after catheter ablation of ventricular tachycardia in patients with nonischemic dilated cardiomyopathy. Circ Arrhythm Electrophysiol 9:e4328PubMed Muser D et al (2016) Longterm outcome after catheter ablation of ventricular tachycardia in patients with nonischemic dilated cardiomyopathy. Circ Arrhythm Electrophysiol 9:e4328PubMed
21.
Zurück zum Zitat Muser D et al (2017) Long-term outcomes of catheter ablation of electrical storm in nonischemic dilated cardiomyopathy compared with ischemic cardiomyopathy. JACC Clin Electrophysiol 3:767–778PubMed Muser D et al (2017) Long-term outcomes of catheter ablation of electrical storm in nonischemic dilated cardiomyopathy compared with ischemic cardiomyopathy. JACC Clin Electrophysiol 3:767–778PubMed
22.
Zurück zum Zitat Dinov B et al (2014) Outcomes in catheter ablation of ventricular tachycardia in dilated nonischemic cardiomyopathy compared with ischemic cardiomyopathy: results from the prospective heart centre of leipzig VT. Circulation 129:728–736PubMed Dinov B et al (2014) Outcomes in catheter ablation of ventricular tachycardia in dilated nonischemic cardiomyopathy compared with ischemic cardiomyopathy: results from the prospective heart centre of leipzig VT. Circulation 129:728–736PubMed
23.
Zurück zum Zitat Gökoğlan Y et al (2016) Scar homogenization versus limited-substrate ablation in patients with nonischemic cardiomyopathy and ventricular tachycardia. J Am Coll Cardiol 68:1990–1998PubMed Gökoğlan Y et al (2016) Scar homogenization versus limited-substrate ablation in patients with nonischemic cardiomyopathy and ventricular tachycardia. J Am Coll Cardiol 68:1990–1998PubMed
24.
Zurück zum Zitat Thiene G et al (2000) Pathology and pathogenesis of arrhythmogenic right ventricular cardiomyopathy. Herz 25(3):210–215PubMed Thiene G et al (2000) Pathology and pathogenesis of arrhythmogenic right ventricular cardiomyopathy. Herz 25(3):210–215PubMed
25.
Zurück zum Zitat Desjardins B et al (2010) Effect of epicardial fat on electroanatomical mapping and epicardial catheter ablation. J Am Coll Cardiol 56(16):1320–1327PubMed Desjardins B et al (2010) Effect of epicardial fat on electroanatomical mapping and epicardial catheter ablation. J Am Coll Cardiol 56(16):1320–1327PubMed
26.
Zurück zum Zitat Santangeli P et al (2015) Long-term outcome with catheter ablation of ventricular tachycardia in patients with arrhythmogenic right ventricular cardiomyopathy. Circ Arrhythm Electrophysiol 8:1413–1421PubMed Santangeli P et al (2015) Long-term outcome with catheter ablation of ventricular tachycardia in patients with arrhythmogenic right ventricular cardiomyopathy. Circ Arrhythm Electrophysiol 8:1413–1421PubMed
27.
Zurück zum Zitat Dalal D et al (2007) Long-term efficacy of catheter ablation of ventricular tachycardia in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy. J Am Coll Cardiol 50(5):432–440PubMed Dalal D et al (2007) Long-term efficacy of catheter ablation of ventricular tachycardia in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy. J Am Coll Cardiol 50(5):432–440PubMed
28.
Zurück zum Zitat Mahida S et al (2019) Ablation compared with drug therapy for recurrent ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy: results from a multicenter study. Heart Rhythm 16:536–543PubMed Mahida S et al (2019) Ablation compared with drug therapy for recurrent ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy: results from a multicenter study. Heart Rhythm 16:536–543PubMed
29.
Zurück zum Zitat Mathew S et al (2019) Catheter ablation of ventricular tachycardia in patients with Arrhythmogenic right ventricular cardiomyopathy/dysplasia: a sequential approach. J Am Heart Assoc 8(5):e10365PubMedPubMedCentral Mathew S et al (2019) Catheter ablation of ventricular tachycardia in patients with Arrhythmogenic right ventricular cardiomyopathy/dysplasia: a sequential approach. J Am Heart Assoc 8(5):e10365PubMedPubMedCentral
32.
Zurück zum Zitat Muser D et al (2018) Identifying risk and management of acutehaemodynamic decompensation during catheter ablation of ventricular tachycardia. Arrhythm Electrophysiol Rev 7:282–287PubMedPubMedCentral Muser D et al (2018) Identifying risk and management of acutehaemodynamic decompensation during catheter ablation of ventricular tachycardia. Arrhythm Electrophysiol Rev 7:282–287PubMedPubMedCentral
33.
Zurück zum Zitat Vergara P et al (2018) Predictive score for identifying survival and recurrence risk profiles in patients undergoing ventricular tachycardia ablation: the I‑VT score. Circ Arrhythm Electrophysiol 11:e6730PubMedPubMedCentral Vergara P et al (2018) Predictive score for identifying survival and recurrence risk profiles in patients undergoing ventricular tachycardia ablation: the I‑VT score. Circ Arrhythm Electrophysiol 11:e6730PubMedPubMedCentral
35.
Zurück zum Zitat Bogun F et al (2009) Delayed-enhanced magnetic resonance imaging in nonischemic cardiomyopathy: utility for identifying the ventricular arrhythmia substrate. J Am Coll Cardiol 53:1138–1145PubMedPubMedCentral Bogun F et al (2009) Delayed-enhanced magnetic resonance imaging in nonischemic cardiomyopathy: utility for identifying the ventricular arrhythmia substrate. J Am Coll Cardiol 53:1138–1145PubMedPubMedCentral
36.
Zurück zum Zitat Dickfeld T et al (2011) MRI-guided ventricular tachycardia ablation: integration of late gadolinium-enhanced 3D scar in patients with implantable cardioverter-defibrillators. Circ Arrhythm Electrophysiol 4:172–184PubMed Dickfeld T et al (2011) MRI-guided ventricular tachycardia ablation: integration of late gadolinium-enhanced 3D scar in patients with implantable cardioverter-defibrillators. Circ Arrhythm Electrophysiol 4:172–184PubMed
37.
Zurück zum Zitat Esposito A et al (2016) Cardiac CT with delayed enhancement in the characterization of ventricular tachycardia structural substrate: relationship between CT-segmented scar and electro-anatomic mapping. JACC Cardiovasc Imaging 9:822–832PubMed Esposito A et al (2016) Cardiac CT with delayed enhancement in the characterization of ventricular tachycardia structural substrate: relationship between CT-segmented scar and electro-anatomic mapping. JACC Cardiovasc Imaging 9:822–832PubMed
38.
Zurück zum Zitat Andreu D et al (2017) Cardiac magnetic resonance-aided scar dechanneling: influence on acute and long-term outcomes. Heart Rhythm 14:1121–1128PubMed Andreu D et al (2017) Cardiac magnetic resonance-aided scar dechanneling: influence on acute and long-term outcomes. Heart Rhythm 14:1121–1128PubMed
39.
Zurück zum Zitat Soto-Iglesias D, Penela D, Jáuregui B, Acosta J, Fernández-Armenta J, Linhart M et al (2020) Cardiac magnetic resonance-guided ventricular tachycardia substrate ablation. JACC Clin Electrophysiol 6:436–447PubMed Soto-Iglesias D, Penela D, Jáuregui B, Acosta J, Fernández-Armenta J, Linhart M et al (2020) Cardiac magnetic resonance-guided ventricular tachycardia substrate ablation. JACC Clin Electrophysiol 6:436–447PubMed
40.
Zurück zum Zitat Rashid S et al (2014) Improved late gadolinium enhancement MR imaging for patients with implanted cardiac devices. Radiology 270:269–274PubMedPubMedCentral Rashid S et al (2014) Improved late gadolinium enhancement MR imaging for patients with implanted cardiac devices. Radiology 270:269–274PubMedPubMedCentral
41.
Zurück zum Zitat Roca-Luque I et al (2020) Ventricular scar channel entrances identified by new wideband cardiac magnetic resonance sequence to guide ventricular tachycardia ablation in patients with cardiac defibrillators. Europace 22:598–606PubMed Roca-Luque I et al (2020) Ventricular scar channel entrances identified by new wideband cardiac magnetic resonance sequence to guide ventricular tachycardia ablation in patients with cardiac defibrillators. Europace 22:598–606PubMed
42.
Zurück zum Zitat Aziz R et al (2019) Targeted ablation of ventricular tachycardia guided by wavefront discontinuities during sinus rhythm. A new functional substrate mapping strategy. Circulation 140:1383–1397PubMed Aziz R et al (2019) Targeted ablation of ventricular tachycardia guided by wavefront discontinuities during sinus rhythm. A new functional substrate mapping strategy. Circulation 140:1383–1397PubMed
43.
Zurück zum Zitat Jackson N et al (2015) Decrement evoked potential mapping: basis of a mechanistic strategy for ventricular tachycardia ablation. Circ Arrhythm Electrophysiol 8:1433–1442PubMed Jackson N et al (2015) Decrement evoked potential mapping: basis of a mechanistic strategy for ventricular tachycardia ablation. Circ Arrhythm Electrophysiol 8:1433–1442PubMed
44.
Zurück zum Zitat Porta-Sánchez A et al (2018) Multicenter study of ischemic ventricular tachycardia ablation with decrement-evoked potential (DEEP) mapping with extra stimulus. JACC Clin Electrophysiol 4:307–315PubMed Porta-Sánchez A et al (2018) Multicenter study of ischemic ventricular tachycardia ablation with decrement-evoked potential (DEEP) mapping with extra stimulus. JACC Clin Electrophysiol 4:307–315PubMed
45.
Zurück zum Zitat Chang RJ, Stevenson WG, Saxon LA, Parker J (1993) Increasing catheter ablation lesion size by simultaneous application of radiofrequency current to two adjacent sites. Am Heart J 125:1276–1284PubMed Chang RJ, Stevenson WG, Saxon LA, Parker J (1993) Increasing catheter ablation lesion size by simultaneous application of radiofrequency current to two adjacent sites. Am Heart J 125:1276–1284PubMed
46.
Zurück zum Zitat Sivagangabalan G et al (2010) Bipolar ablation of the interventricular septum is more efficient at creating a transmural line than sequential unipolar ablation. Pacing Clin Electrophysiol 33:16–26PubMed Sivagangabalan G et al (2010) Bipolar ablation of the interventricular septum is more efficient at creating a transmural line than sequential unipolar ablation. Pacing Clin Electrophysiol 33:16–26PubMed
48.
Zurück zum Zitat Igarashi M et al (2020) Acute and long-term results of bipolar radiofrequency catheter ablation of refractory ventricular arrhythmias of deep intramural origin. Heart Rhythm 17:1500–1507PubMed Igarashi M et al (2020) Acute and long-term results of bipolar radiofrequency catheter ablation of refractory ventricular arrhythmias of deep intramural origin. Heart Rhythm 17:1500–1507PubMed
49.
Zurück zum Zitat Nguyen DT et al (2015) Effect of irrigant characteristics on lesion formation after radiofrequency energy delivery using ablation catheters with actively cooled tips. J Cardiovasc Electrophysiol 26:792–798PubMed Nguyen DT et al (2015) Effect of irrigant characteristics on lesion formation after radiofrequency energy delivery using ablation catheters with actively cooled tips. J Cardiovasc Electrophysiol 26:792–798PubMed
50.
Zurück zum Zitat Stevenson WG et al (2019) Infusion needle radiofrequency abaltion for treatment of refractory ventricular arrhythmias. J Am Coll Cardiol 73:1413–1425PubMed Stevenson WG et al (2019) Infusion needle radiofrequency abaltion for treatment of refractory ventricular arrhythmias. J Am Coll Cardiol 73:1413–1425PubMed
51.
Zurück zum Zitat Koruth JS et al (2020) Endocardiac ventricular pulsed field ablation: a proof-of-concept preclinical evaluation. Europace 22:434–439PubMed Koruth JS et al (2020) Endocardiac ventricular pulsed field ablation: a proof-of-concept preclinical evaluation. Europace 22:434–439PubMed
52.
Zurück zum Zitat Chen M et al (2020) Pan-Asia United States prevention of sudden cardiac death catheter ablation trial (PAUSE-SCD): rationale and study design. J Interv Card Electrophysiol 57(2):271–278PubMed Chen M et al (2020) Pan-Asia United States prevention of sudden cardiac death catheter ablation trial (PAUSE-SCD): rationale and study design. J Interv Card Electrophysiol 57(2):271–278PubMed
Metadaten
Titel
Update Ablation ventrikulärer Tachyarrhythmien
verfasst von
Shibu Mathew
Dr. med. Patrick Müller
Carina Hardy
Mauricio Ibrahim Scanavacca
Thomas Deneke
Publikationsdatum
14.02.2022
Verlag
Springer Medizin
Erschienen in
Herzschrittmachertherapie + Elektrophysiologie / Ausgabe 1/2022
Print ISSN: 0938-7412
Elektronische ISSN: 1435-1544
DOI
https://doi.org/10.1007/s00399-022-00840-4

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