Procedural Adaptations to Avoid Haemodynamic Instability During Catheter Ablation of Scar-related Ventricular Tachycardia.

Autor:	Freedman BL; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US., Maher TR; Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US., Tracey M; Biosense Webster, Irvine, CA, US., Santangeli P; Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, US., d'Avila A; Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US.
Jazyk:	angličtina
Zdroj:	Arrhythmia & electrophysiology review [Arrhythm Electrophysiol Rev] 2023 Jun 23; Vol. 12, pp. e20. Date of Electronic Publication: 2023 Jun 23 (Print Publication: 2023).
DOI:	10.15420/aer.2022.24
Abstrakt:	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. Competing Interests: Disclosure: MT is an employee of Biosense Webster. All other authors have no conflicts of interest to declare. (Copyright © 2023, Radcliffe Cardiology.)
Databáze:	MEDLINE
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