Procedural Adaptations to Avoid Haemodynamic Instability During Catheter Ablation of Scar-related Ventricular Tachycardia
Classically, catheter ablation for scar-related ventricular tachycardia (VT) relied upon activation and entrainment mapping of induced VT. Advances in post-MI therapies have led to VTs that are faster and haemodynamically less stable, because of more heterogeneous myocardial fibrosis patterns. The P...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Radcliffe Medical Media
2023-06-01
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| Series: | Arrhythmia & Electrophysiology Review |
| Online Access: | https://www.aerjournal.com/articleindex/aer.2022.24 |
| _version_ | 1826933125111873536 |
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| author | Benjamin L Freedman Timothy R Maher Madison Tracey Pasquale Santangeli Andre d’Avila |
| author_facet | Benjamin L Freedman Timothy R Maher Madison Tracey Pasquale Santangeli Andre d’Avila |
| author_sort | Benjamin L Freedman |
| collection | DOAJ |
| description | Classically, catheter ablation for scar-related ventricular tachycardia (VT) relied upon activation and entrainment mapping of induced VT. Advances in post-MI therapies have led to VTs that are faster and haemodynamically less stable, because of more heterogeneous myocardial fibrosis patterns. The PAINESD score is one means of identifying patients at highest risk for haemodynamic decompensation during attempted VT induction, who may, therefore, benefit from alternative ablation strategies. One strategy is to use temporary mechanical circulatory support, although this warrants formal assessment of cost-effectiveness. A second strategy is to minimise or avoid VT induction altogether by employing a family of ‘substrate’-based approaches aimed at identifying VT isthmuses during sinus or paced rhythm. Substrate mapping techniques are diverse, and focus on the timing, morphology and amplitude of local ventricular electrograms – sometimes aided by advanced non-invasive cardiac imaging modalities. In this review, the evolution of VT ablation over time is discussed, with an emphasis on procedural adaptations to the challenge of haemodynamic instability. |
| first_indexed | 2024-03-07T17:39:53Z |
| format | Article |
| id | doaj.art-54f53b0dcba34515b2d3bb9465618493 |
| institution | Directory Open Access Journal |
| issn | 2050-3369 2050-3377 |
| language | English |
| last_indexed | 2025-02-17T17:27:01Z |
| publishDate | 2023-06-01 |
| publisher | Radcliffe Medical Media |
| record_format | Article |
| series | Arrhythmia & Electrophysiology Review |
| spelling | doaj.art-54f53b0dcba34515b2d3bb94656184932024-12-14T16:04:32ZengRadcliffe Medical MediaArrhythmia & Electrophysiology Review2050-33692050-33772023-06-011210.15420/aer.2022.24Procedural Adaptations to Avoid Haemodynamic Instability During Catheter Ablation of Scar-related Ventricular TachycardiaBenjamin L Freedman0Timothy R Maher1Madison Tracey2Pasquale Santangeli3Andre d’Avila4Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USHarvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USBiosense Webster, Irvine, CA, USCardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USHarvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USClassically, catheter ablation for scar-related ventricular tachycardia (VT) relied upon activation and entrainment mapping of induced VT. Advances in post-MI therapies have led to VTs that are faster and haemodynamically less stable, because of more heterogeneous myocardial fibrosis patterns. The PAINESD score is one means of identifying patients at highest risk for haemodynamic decompensation during attempted VT induction, who may, therefore, benefit from alternative ablation strategies. One strategy is to use temporary mechanical circulatory support, although this warrants formal assessment of cost-effectiveness. A second strategy is to minimise or avoid VT induction altogether by employing a family of ‘substrate’-based approaches aimed at identifying VT isthmuses during sinus or paced rhythm. Substrate mapping techniques are diverse, and focus on the timing, morphology and amplitude of local ventricular electrograms – sometimes aided by advanced non-invasive cardiac imaging modalities. In this review, the evolution of VT ablation over time is discussed, with an emphasis on procedural adaptations to the challenge of haemodynamic instability.https://www.aerjournal.com/articleindex/aer.2022.24 |
| spellingShingle | Benjamin L Freedman Timothy R Maher Madison Tracey Pasquale Santangeli Andre d’Avila Procedural Adaptations to Avoid Haemodynamic Instability During Catheter Ablation of Scar-related Ventricular Tachycardia Arrhythmia & Electrophysiology Review |
| title | Procedural Adaptations to Avoid Haemodynamic Instability During Catheter Ablation of Scar-related Ventricular Tachycardia |
| title_full | Procedural Adaptations to Avoid Haemodynamic Instability During Catheter Ablation of Scar-related Ventricular Tachycardia |
| title_fullStr | Procedural Adaptations to Avoid Haemodynamic Instability During Catheter Ablation of Scar-related Ventricular Tachycardia |
| title_full_unstemmed | Procedural Adaptations to Avoid Haemodynamic Instability During Catheter Ablation of Scar-related Ventricular Tachycardia |
| title_short | Procedural Adaptations to Avoid Haemodynamic Instability During Catheter Ablation of Scar-related Ventricular Tachycardia |
| title_sort | procedural adaptations to avoid haemodynamic instability during catheter ablation of scar related ventricular tachycardia |
| url | https://www.aerjournal.com/articleindex/aer.2022.24 |
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