1932

Abstract

Recurrent ventricular arrhythmias (VAs) are a leading cause of cardiovascular morbidity and mortality. In the last three decades, important advancements have occurred in the understanding of the mechanisms of recurrent VAs, their prognostic implications in different clinical contexts, and their treatment options. VAs occur in structurally normal hearts as well as in patients with underlying heart disease, but the latter group has a particularly high risk of recurrent VAs. Catheter ablation offers the possibility of cure for a substantial proportion of patients. Research has focused on identifying optimal targets for ablation, correlating the underlying structural abnormalities with the site of origin of VAs, and determining the optimal procedural approach. Ablation therapy can be life-saving in select patients with high burden of repetitive VAs or advanced heart failure syndromes. This article focuses on clinical aspects of catheter ablation of VAs, particularly the selection and clinical management of patients undergoing catheter ablation procedures and expected outcomes.

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2020-01-27
2024-03-29
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Literature Cited

  1. 1. 
    Bigger JT Jr., Fleiss JL, Kleiger R et al. 1984. The relationships among ventricular arrhythmias, left ventricular dysfunction, and mortality in the 2 years after myocardial infarction. Circulation 69:250–58
    [Google Scholar]
  2. 2. 
    Chiang BN, Perlman LV, Ostrander LD Jr., Epstein FH 1969. Relationship of premature systoles to coronary heart disease and sudden death in the Tecumseh epidemiologic study. Ann. Intern. Med. 70:1159–66
    [Google Scholar]
  3. 3. 
    Hirose H, Ishikawa S, Gotoh T et al. 2010. Cardiac mortality of premature ventricular complexes in healthy people in Japan. J. Cardiol. 56:23–26
    [Google Scholar]
  4. 4. 
    Ruberman W, Weinblatt E, Goldberg JD et al. 1977. Ventricular premature beats and mortality after myocardial infarction. N. Engl. J. Med. 297:750–57
    [Google Scholar]
  5. 5. 
    Ataklte F, Erqou S, Laukkanen J, Kaptoge S 2013. Meta-analysis of ventricular premature complexes and their relation to cardiac mortality in general populations. Am. J. Cardiol. 112:1263–70
    [Google Scholar]
  6. 6. 
    Dukes JW, Dewland TA, Vittinghoff E et al. 2015. Ventricular ectopy as a predictor of heart failure and death. J. Am. Coll. Cardiol. 66:101–9
    [Google Scholar]
  7. 7. 
    Cronin EM, Bogun FM, Maury P et al. 2019. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J. Arrhythm. 35:323–84
    [Google Scholar]
  8. 8. 
    Epstein AE, DiMarco JP, Ellenbogen KA et al. 2013. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J. Am. Coll. Cardiol. 61:e6–75
    [Google Scholar]
  9. 9. 
    Poole JE, Johnson GW, Hellkamp AS et al. 2008. Prognostic importance of defibrillator shocks in patients with heart failure. N. Engl. J. Med. 359:1009–17
    [Google Scholar]
  10. 10. 
    Santangeli P, Muser D, Maeda S et al. 2016. Comparative effectiveness of antiarrhythmic drugs and catheter ablation for the prevention of recurrent ventricular tachycardia in patients with implantable cardioverter-defibrillators: a systematic review and meta-analysis of randomized controlled trials. Heart Rhythm 13:1552–59
    [Google Scholar]
  11. 11. 
    Pathak RK, Ariyarathna N, Garcia FC et al. 2019. Catheter ablation of idiopathic ventricular arrhythmias. Heart Lung Circ 28:102–9
    [Google Scholar]
  12. 12. 
    Dello Russo A, Pieroni M, Santangeli P et al. 2011. Concealed cardiomyopathies in competitive athletes with ventricular arrhythmias and an apparently normal heart: role of cardiac electroanatomical mapping and biopsy. Heart Rhythm 8:1915–22
    [Google Scholar]
  13. 13. 
    Agarwal V, Vittinghoff E, Whitman IR et al. 2017. Relation between ventricular premature complexes and incident heart failure. Am. J. Cardiol. 119:1238–42
    [Google Scholar]
  14. 14. 
    Knecht S, Sacher F, Wright M et al. 2009. Long-term follow-up of idiopathic ventricular fibrillation ablation: a multicenter study. J. Am. Coll. Cardiol. 54:522–28
    [Google Scholar]
  15. 15. 
    Yokokawa M, Siontis KC, Kim HM et al. 2017. Value of cardiac magnetic resonance imaging and programmed ventricular stimulation in patients with frequent premature ventricular complexes undergoing radiofrequency ablation. Heart Rhythm 14:1695–701
    [Google Scholar]
  16. 16. 
    Nucifora G, Muser D, Masci PG et al. 2014. Prevalence and prognostic value of concealed structural abnormalities in patients with apparently idiopathic ventricular arrhythmias of left versus right ventricular origin: a magnetic resonance imaging study. Circ. Arrhythm. Electrophysiol. 7:456–62
    [Google Scholar]
  17. 17. 
    Van Herendael H, Garcia F, Lin D et al. 2011. Idiopathic right ventricular arrhythmias not arising from the outflow tract: prevalence, electrocardiographic characteristics, and outcome of catheter ablation. Heart Rhythm 8:511–18
    [Google Scholar]
  18. 18. 
    Sadek MM, Benhayon D, Sureddi R et al. 2015. Idiopathic ventricular arrhythmias originating from the moderator band: electrocardiographic characteristics and treatment by catheter ablation. Heart Rhythm 12:67–75
    [Google Scholar]
  19. 19. 
    Tada H, Tadokoro K, Miyaji K et al. 2008. Idiopathic ventricular arrhythmias arising from the pulmonary artery: prevalence, characteristics, and topography of the arrhythmia origin. Heart Rhythm 5:419–26
    [Google Scholar]
  20. 20. 
    Yamada T, Yoshida N, Itoh T et al. 2017. Idiopathic ventricular arrhythmias originating from the parietal band: electrocardiographic and electrophysiological characteristics and outcome of catheter ablation. Circ. Arrhythm. Electrophysiol. 10: https://doi.org/10.1161/CIRCEP.117.005099
    [Crossref] [Google Scholar]
  21. 21. 
    Yamada T, Yoshida N, Litovsky SH et al. 2018. Idiopathic ventricular arrhythmias originating from the infundibular muscles: prevalence, electrocardiographic and electrophysiological characteristics, and outcome of catheter ablation. Circ. Arrhythm. Electrophysiol. 11:e005749
    [Google Scholar]
  22. 22. 
    Thakur RK, Klein GJ, Sivaram CA et al. 1996. Anatomic substrate for idiopathic left ventricular tachycardia. Circulation 93:497–501
    [Google Scholar]
  23. 23. 
    Lopera G, Stevenson WG, Soejima K et al. 2004. Identification and ablation of three types of ventricular tachycardia involving the His-Purkinje system in patients with heart disease. J. Cardiovasc. Electrophysiol. 15:52–58
    [Google Scholar]
  24. 24. 
    Kumar S, Romero J, Mehta NK et al. 2016. Long-term outcomes after catheter ablation of ventricular tachycardia in patients with and without structural heart disease. Heart Rhythm 13:1957–63
    [Google Scholar]
  25. 25. 
    Van Herendael H, Zado ES, Haqqani H et al. 2014. Catheter ablation of ventricular fibrillation: importance of left ventricular outflow tract and papillary muscle triggers. Heart Rhythm 11:566–73
    [Google Scholar]
  26. 26. 
    Latchamsetty R, Yokokawa M, Morady F et al. 2015. Multicenter outcomes for catheter ablation of idiopathic premature ventricular complexes. JACC Clin. Electrophysiol. 1:116–23
    [Google Scholar]
  27. 27. 
    Santangeli P, Marchlinski FE, Zado ES et al. 2015. Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit: outcomes and electrocardiogram correlates of success. Circ. Arrhythm. Electrophysiol. 8:337–43
    [Google Scholar]
  28. 28. 
    Enriquez A, Shirai Y, Huang J et al. 2019. Papillary muscle ventricular arrhythmias in patients with arrhythmic mitral valve prolapse: electrophysiologic substrate and catheter ablation outcomes. J. Cardiovasc. Electrophysiol. 30:827–35
    [Google Scholar]
  29. 29. 
    Yang J, Liang J, Shirai Y et al. 2018. Outcomes of simultaneous unipolar radiofrequency catheter ablation for intramural septal ventricular tachycardia in nonischemic cardiomyopathy. Heart Rhythm 16:863–70
    [Google Scholar]
  30. 30. 
    Yamada T, Maddox WR, McElderry HT et al. 2015. Radiofrequency catheter ablation of idiopathic ventricular arrhythmias originating from intramural foci in the left ventricular outflow tract: efficacy of sequential versus simultaneous unipolar catheter ablation. Circ. Arrhythm. Electrophysiol. 8:344–52
    [Google Scholar]
  31. 31. 
    Sandhu A, Schuller JL, Tzou WS et al. 2019. Use of half-normal saline irrigant with cooled radiofrequency ablation within the great cardiac vein to ablate premature ventricular contractions arising from the left ventricular summit. Pacing Clin. Electrophysiol. 42:301–5
    [Google Scholar]
  32. 32. 
    Gordon JP, Liang JJ, Pathak RK et al. 2018. Percutaneous cryoablation for papillary muscle ventricular arrhythmias after failed radiofrequency catheter ablation. J. Cardiovasc. Electrophysiol. 29:1654–63
    [Google Scholar]
  33. 33. 
    Mountantonakis SE, Frankel DS, Gerstenfeld EP et al. 2011. Reversal of outflow tract ventricular premature depolarization-induced cardiomyopathy with ablation: effect of residual arrhythmia burden and preexisting cardiomyopathy on outcome. Heart Rhythm 8:1608–14
    [Google Scholar]
  34. 34. 
    El Kadri M, Yokokawa M, Labounty T et al. 2015. Effect of ablation of frequent premature ventricular complexes on left ventricular function in patients with nonischemic cardiomyopathy. Heart Rhythm 12:706–13
    [Google Scholar]
  35. 35. 
    Sarrazin JF, Labounty T, Kuhne M et al. 2009. Impact of radiofrequency ablation of frequent post-infarction premature ventricular complexes on left ventricular ejection fraction. Heart Rhythm 6:1543–49
    [Google Scholar]
  36. 36. 
    Carballeira Pol L, Deyell MW, Frankel DS et al. 2014. Ventricular premature depolarization QRS duration as a new marker of risk for the development of ventricular premature depolarization-induced cardiomyopathy. Heart Rhythm 11:299–306
    [Google Scholar]
  37. 37. 
    Deyell MW, Park KM, Han Y et al. 2012. Predictors of recovery of left ventricular dysfunction after ablation of frequent ventricular premature depolarizations. Heart Rhythm 9:1465–72
    [Google Scholar]
  38. 38. 
    Baman TS, Lange DC, Ilg KJ et al. 2010. Relationship between burden of premature ventricular complexes and left ventricular function. Heart Rhythm 7:865–69
    [Google Scholar]
  39. 39. 
    de Bakker JM, van Capelle FJ, Janse MJ et al. 1991. Macroreentry in the infarcted human heart: the mechanism of ventricular tachycardias with a “focal” activation pattern. J. Am. Coll. Cardiol. 18:1005–14
    [Google Scholar]
  40. 40. 
    de Bakker JM, van Capelle FJ, Janse MJ et al. 1988. Reentry as a cause of ventricular tachycardia in patients with chronic ischemic heart disease: electrophysiologic and anatomic correlation. Circulation 77:589–606
    [Google Scholar]
  41. 41. 
    Downar E, Harris L, Mickleborough LL et al. 1988. Endocardial mapping of ventricular tachycardia in the intact human ventricle: evidence for reentrant mechanisms. J. Am. Coll. Cardiol. 11:783–91
    [Google Scholar]
  42. 42. 
    Reddy VY, Reynolds MR, Neuzil P et al. 2007. Prophylactic catheter ablation for the prevention of defibrillator therapy. N. Engl. J. Med. 357:2657–65
    [Google Scholar]
  43. 43. 
    Kuck KH, Schaumann A, Eckardt L et al. 2010. Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial. Lancet 375:31–40
    [Google Scholar]
  44. 44. 
    Bunch TJ, Weiss JP, Crandall BG et al. 2014. Patients treated with catheter ablation for ventricular tachycardia after an ICD shock have lower long-term rates of death and heart failure hospitalization than do patients treated with medical management only. Heart Rhythm 11:533–40
    [Google Scholar]
  45. 45. 
    Di Biase L, Burkhardt JD, Lakkireddy D et al. 2015. Ablation of stable VTs versus substrate ablation in ischemic cardiomyopathy: the VISTA randomized multicenter trial. J. Am. Coll. Cardiol. 66:2872–82
    [Google Scholar]
  46. 46. 
    Sapp JL, Wells GA, Parkash R et al. 2016. Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs. N. Engl. J. Med. 375:111–21
    [Google Scholar]
  47. 47. 
    Muser D, Liang JJ, Pathak RK et al. 2017. Long-term outcomes of catheter ablation of electrical storm in nonischemic dilated cardiomyopathy compared with ischemic cardiomyopathy. JACC Clin. Electrophysiol. 3:767–78
    [Google Scholar]
  48. 48. 
    Muser D, Santangeli P, Castro SA et al. 2016. Long-term outcome after catheter ablation of ventricular tachycardia in patients with nonischemic dilated cardiomyopathy. Circ. Arrhythm. Electrophysiol. 9:e004328
    [Google Scholar]
  49. 49. 
    Tung R, Vaseghi M, Frankel DS 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 12:1997–2007
    [Google Scholar]
  50. 50. 
    Marchlinski FE, Callans DJ, Gottlieb CD, Zado E 2000. Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy. Circulation 101:1288–96
    [Google Scholar]
  51. 51. 
    Santangeli P, Marchlinski FE. 2016. Substrate mapping for unstable ventricular tachycardia. Heart Rhythm 13:569–83
    [Google Scholar]
  52. 52. 
    Hsia HH, Callans DJ, Marchlinski FE 2003. Characterization of endocardial electrophysiological substrate in patients with nonischemic cardiomyopathy and monomorphic ventricular tachycardia. Circulation 108:704–10
    [Google Scholar]
  53. 53. 
    Sosa E, Scanavacca M, D'Avila A et al. 1999. Radiofrequency catheter ablation of ventricular tachycardia guided by nonsurgical epicardial mapping in chronic Chagasic heart disease. Pacing Clin. Electrophysiol. 22:128–30
    [Google Scholar]
  54. 54. 
    Santangeli P, Tung R, Xue Y et al. 2019. Outcomes of catheter ablation in arrhythmogenic right ventricular cardiomyopathy without background implantable cardioverter defibrillator therapy: a multicenter international ventricular tachycardia registry. JACC Clin. Electrophysiol. 5:55–65
    [Google Scholar]
  55. 55. 
    Santangeli P, Zado ES, Supple GE et al. 2015. Long-term outcome with catheter ablation of ventricular tachycardia in patients with arrhythmogenic right ventricular cardiomyopathy. Circ. Arrhythm. Electrophysiol. 8:1413–21
    [Google Scholar]
  56. 56. 
    Haqqani HM, Tschabrunn CM, Tzou WS et al. 2011. Isolated septal substrate for ventricular tachycardia in nonischemic dilated cardiomyopathy: incidence, characterization, and implications. Heart Rhythm 8:1169–76
    [Google Scholar]
  57. 57. 
    Teh AW, Reddy VY, Koruth JS et al. 2014. Bipolar radiofrequency catheter ablation for refractory ventricular outflow tract arrhythmias. J. Cardiovasc. Electrophysiol. 25:1093–99
    [Google Scholar]
  58. 58. 
    Kreidieh B, Rodriguez-Manero M, Schurmann P et al. 2016. Retrograde coronary venous ethanol infusion for ablation of refractory ventricular tachycardia. Circ. Arrhythm. Electrophysiol. 9: https://doi.org/10.1161/CIRCEP.116.004352
    [Crossref] [Google Scholar]
  59. 59. 
    Nguyen DT, Gerstenfeld EP, Tzou WS et al. 2017. Radiofrequency ablation using an open irrigated electrode cooled with half-normal saline. JACC Clin. Electrophysiol. 3:1103–10
    [Google Scholar]
  60. 60. 
    Santangeli P, Muser D, Zado ES et al. 2015. Acute hemodynamic decompensation during catheter ablation of scar-related ventricular tachycardia: incidence, predictors, and impact on mortality. Circ. Arrhythm. Electrophysiol. 8:68–75
    [Google Scholar]
  61. 61. 
    Enriquez A, Liang J, Gentile J et al. 2018. Outcomes of rescue cardiopulmonary support for periprocedural acute hemodynamic decompensation in patients undergoing catheter ablation of electrical storm. Heart Rhythm 15:75–80
    [Google Scholar]
  62. 62. 
    Santangeli P, Frankel DS, Tung R et al. 2017. Early mortality after catheter ablation of ventricular tachycardia in patients with structural heart disease. J. Am. Coll. Cardiol. 69:2105–15
    [Google Scholar]
  63. 63. 
    Muser D, Liang JJ, Castro SA et al. 2018. Outcomes with prophylactic use of percutaneous left ventricular assist devices in high-risk patients undergoing catheter ablation of scar-related ventricular tachycardia: a propensity-score matched analysis. Heart Rhythm 15:1500–6
    [Google Scholar]
  64. 64. 
    Pedrotty DM, Rame JE, Margulies KB 2013. Management of ventricular arrhythmias in patients with ventricular assist devices. Curr. Opin. Cardiol. 28:360–68
    [Google Scholar]
  65. 65. 
    Ambardekar AV, Allen LA, Lindenfeld J et al. 2010. Implantable cardioverter-defibrillator shocks in patients with a left ventricular assist device. J. Heart Lung Transplant. 29:771–76
    [Google Scholar]
  66. 66. 
    Bedi M, Kormos R, Winowich S et al. 2007. Ventricular arrhythmias during left ventricular assist device support. Am. J. Cardiol. 99:1151–53
    [Google Scholar]
  67. 67. 
    Sacher F, Reichlin T, Zado ES et al. 2015. Characteristics of ventricular tachycardia ablation in patients with continuous flow left ventricular assist devices. Circ. Arrhythm. Electrophysiol. 8:592–97
    [Google Scholar]
  68. 68. 
    Dandamudi G, Ghumman WS, Das MK, Miller JM 2007. Endocardial catheter ablation of ventricular tachycardia in patients with ventricular assist devices. Heart Rhythm 4:1165–69
    [Google Scholar]
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