Catheter Ablation of Ventricular Tachycardia in Structural Heart Disease: Indications, Strategies, and Outcomes-Part II

In contrast to ventricular tachycardia (VT) that occurs in the setting of a structurally normal heart, VT that occurs in patients with structural heart disease carries an elevated risk for sudden cardiac death (SCD), and implantable cardioverter-defibrillators (ICDs) are the mainstay of therapy. In...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2017-12, Vol.70 (23), p.2924-2941
Main Authors: Dukkipati, Srinivas R, Koruth, Jacob S, Choudry, Subbarao, Miller, Marc A, Whang, William, Reddy, Vivek Y
Format: Article
Language:English
Subjects:
Ablation
Arrhythmia
Cardiac arrhythmia
Cardiology
Cardiomyopathy
Cardiovascular disease
Catheter Ablation
Catheters
Coronary artery disease
Defibrillators
Disease control
Health risks
Heart
Heart attacks
Heart diseases
Heart Diseases - complications
Heart Diseases - physiopathology
Heart Diseases - surgery
Humans
Implantation
Morphology
Patient Selection
Patients
Radiofrequency ablation
Studies
Tachycardia
Tachycardia, Ventricular - pathology
Tachycardia, Ventricular - physiopathology
Tachycardia, Ventricular - surgery
Treatment Outcome
Ventricle
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Summary:In contrast to ventricular tachycardia (VT) that occurs in the setting of a structurally normal heart, VT that occurs in patients with structural heart disease carries an elevated risk for sudden cardiac death (SCD), and implantable cardioverter-defibrillators (ICDs) are the mainstay of therapy. In these individuals, catheter ablation may be used as adjunctive therapy to treat or prevent repetitive ICD therapies when antiarrhythmic drugs are ineffective or not desired. However, certain patients with frequent premature ventricular contractions (PVCs) or VT and tachycardiomyopathy should be considered for ablation before ICD implantation because left ventricular function may improve, consequently decreasing the risk of SCD and obviating the need for an ICD. The goal of this paper is to review the pathophysiology, mechanism, and management of VT in the setting of structural heart disease and discuss the evolving role of catheter ablation in decreasing ventricular arrhythmia recurrence.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2017.10.030