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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...

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Autores principales: Freedman, Benjamin L, Maher, Timothy R, Tracey, Madison, Santangeli, Pasquale, d'Avila, Andre
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Radcliffe Cardiology 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10350657/
https://www.ncbi.nlm.nih.gov/pubmed/37465104
http://dx.doi.org/10.15420/aer.2022.24
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author Freedman, Benjamin L
Maher, Timothy R
Tracey, Madison
Santangeli, Pasquale
d'Avila, Andre
author_facet Freedman, Benjamin L
Maher, Timothy R
Tracey, Madison
Santangeli, Pasquale
d'Avila, Andre
author_sort Freedman, Benjamin L
collection PubMed
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.
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spelling pubmed-103506572023-07-18 Procedural Adaptations to Avoid Haemodynamic Instability During Catheter Ablation of Scar-related Ventricular Tachycardia Freedman, Benjamin L Maher, Timothy R Tracey, Madison Santangeli, Pasquale d'Avila, Andre Arrhythm Electrophysiol Rev Clinical Electrophysiology and Ablation 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. Radcliffe Cardiology 2023-06-23 /pmc/articles/PMC10350657/ /pubmed/37465104 http://dx.doi.org/10.15420/aer.2022.24 Text en Copyright © 2023, Radcliffe Cardiology https://creativecommons.org/licenses/by-nc/4.0/This work is open access under the CC-BY-NC 4.0 License which allows users to copy, redistribute and make derivative works for non-commercial purposes, provided the original work is cited correctly.
spellingShingle Clinical Electrophysiology and Ablation
Freedman, Benjamin L
Maher, Timothy R
Tracey, Madison
Santangeli, Pasquale
d'Avila, Andre
Procedural Adaptations to Avoid Haemodynamic Instability During Catheter Ablation of Scar-related Ventricular Tachycardia
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
topic Clinical Electrophysiology and Ablation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10350657/
https://www.ncbi.nlm.nih.gov/pubmed/37465104
http://dx.doi.org/10.15420/aer.2022.24
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