Skip to main content

Ventricular Tachycardia with Structural Heart Disease

  • 358 Accesses

Abstract

Ventricular tachycardia (VT) is a major cause of sudden cardiac death. The majority of malignant VTs which carry an elevated risk for sudden cardiac death (SCD), occur in patients with structural heart disease (SHD); currently implantable cardioverter defibrillators (ICDs) are the mainstay of therapy [1]. In these individuals, catheter ablation is being increasingly performed as adjunctive therapy to prevent or reduce ICD therapies when antiarrhythmic drugs are ineffective or contraindicated. In addition, in developing countries, some VT patients with structural heart disease cannot afford the expense of ICD; antiarrhythmic drugs and catheter ablation may become the ultimate therapy to prevent VTs and the onset of SCD.

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-030-16992-3_13
  • Chapter length: 19 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   109.00
Price excludes VAT (USA)
  • ISBN: 978-3-030-16992-3
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   149.99
Price excludes VAT (USA)
Hardcover Book
USD   199.99
Price excludes VAT (USA)
Fig. 13.1
Fig. 13.2
Fig. 13.3
Fig. 13.4
Fig. 13.5
Fig. 13.6
Fig. 13.7
Fig. 13.8

References

  1. Priori SG, Blomstrom-Lundqvist C, Mazzanti A, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2015;36:2793–867.

    CrossRef  Google Scholar 

  2. Perisinakis K, Damilakis J, Theocharopoulos N, et al. Accurate assessment of patient effective radiation dose and associated detriment risk from radiofrequency catheter ablation procedures. Circulation. 2001;104:58–62.

    CAS  CrossRef  Google Scholar 

  3. Packer DL. Three-dimensional mapping in interventional electrophysiology: techniques and technology. J Cardiovasc Electrophysiol. 2005;16:1110–6.

    CrossRef  Google Scholar 

  4. Casella M, Pelargonio G, Dello RA, et al. “Near-zero” fluoroscopic exposure in supraventricular arrhythmia ablation using the EnSite NavX mapping system: personal experience and review of the literature. J Interv Card Electrophysiol. 2011;31:109–18.

    CrossRef  Google Scholar 

  5. Cherry EM, Fenton FH, Gilmour RJ. Mechanisms of ventricular arrhythmias: a dynamical systems-based perspective. Am J Physiol Heart Circ Physiol. 2012;302:H2451–63.

    CAS  CrossRef  Google Scholar 

  6. Pandit SV, Jalife J. Rotors and the dynamics of cardiac fibrillation. Circ Res. 2013;112:849–62.

    CAS  CrossRef  Google Scholar 

  7. Lerman BB. Mechanism, diagnosis, and treatment of outflow tract tachycardia. Nat Rev Cardiol. 2015;12:597–608.

    CAS  CrossRef  Google Scholar 

  8. Zhang J, Cooper DH, Desouza KA, et al. Electrophysiologic scar substrate in relation to VT: noninvasive high-resolution mapping and risk assessment with ECGI. Pacing Clin Electrophysiol. 2016;39:781–91.

    CrossRef  Google Scholar 

  9. Fernandez-Armenta J, Penela D, Acosta J, et al. Substrate modification or ventricular tachycardia induction, mapping, and ablation as the first step? A randomized study. Heart Rhythm. 2016;13:1589–95.

    CrossRef  Google Scholar 

  10. Tsuji Y, Heijman J, Nattel S, et al. Electrical storm: recent pathophysiological insights and therapeutic consequences. Basic Res Cardiol. 2013;108:336.

    CrossRef  Google Scholar 

  11. Bogun FM, Desjardins B, Good E, et al. Delayed-enhanced magnetic resonance imaging in nonischemic cardiomyopathy: utility for identifying the ventricular arrhythmia substrate. J Am Coll Cardiol. 2009;53:1138–45.

    CrossRef  Google Scholar 

  12. Andreu D, Ortiz-Perez JT, Boussy T, et al. Usefulness of contrast-enhanced cardiac magnetic resonance in identifying the ventricular arrhythmia substrate and the approach needed for ablation. Eur Heart J. 2014;35:1316–26.

    CrossRef  Google Scholar 

  13. Dickfeld T, Tian J, Ahmad G, et al. MRI-guided ventricular tachycardia ablation: integration of late gadolinium-enhanced 3D scar in patients with implantable cardioverter-defibrillators. Circ Arrhythm Electrophysiol. 2011;4:172–84.

    CrossRef  Google Scholar 

  14. Yamashita S, Sacher F, Mahida S, et al. Image integration to guide catheter ablation in scar-related ventricular tachycardia. J Cardiovasc Electrophysiol. 2016;27:699–708.

    CrossRef  Google Scholar 

  15. Soto-Iglesias D, Acosta J, Penela D, et al. Image-based criteria to identify the presence of epicardial arrhythmogenic substrate in patients with transmural myocardial infarction. Heart Rhythm. 2018;15(6):814–21.

    CrossRef  Google Scholar 

  16. Komatsu Y, Cochet H, Jadidi A, et al. Regional myocardial wall thinning at multidetector computed tomography correlates to arrhythmogenic substrate in postinfarction ventricular tachycardia: assessment of structural and electrical substrate. Circ Arrhythm Electrophysiol. 2013;6:342–50.

    CrossRef  Google Scholar 

  17. Wu LM, Bao JR, Yao Y, et al. Fast rate (≥250 beats/min) right ventricular burst stimulation is useful for ventricular tachycardia induction in arrhythmogenic right ventricular cardiomyopathy. J Geriatr Cardiol. 2016;13:70–4.

    PubMed  PubMed Central  Google Scholar 

  18. Stevenson WG, Friedman PL, Kocovic D, et al. Radiofrequency catheter ablation of ventricular tachycardia after myocardial infarction. Circulation. 1998;98:308–14.

    CAS  CrossRef  Google Scholar 

  19. Josephson ME, Anter E. Substrate mapping for ventricular tachycardia: assumptions and misconceptions. JACC Clin Electrophysiol. 2015;1:341–52.

    CrossRef  Google Scholar 

  20. Soejima K, Suzuki M, Maisel WH, et al. Catheter ablation in patients with multiple and unstable ventricular tachycardias after myocardial infarction: short ablation lines guided by reentry circuit isthmuses and sinus rhythm mapping. Circulation. 2001;104:664–9.

    CAS  CrossRef  Google Scholar 

  21. Harada T, Stevenson WG, Kocovic DZ, et al. Catheter ablation of ventricular tachycardia after myocardial infarction: relation of endocardial sinus rhythm late potentials to the reentry circuit. J Am Coll Cardiol. 1997;30:1015–23.

    CAS  CrossRef  Google Scholar 

  22. Arenal A, Glez-Torrecilla E, Ortiz M, et al. Ablation of electrograms with an isolated, delayed component as treatment of unmappable monomorphic ventricular tachycardias in patients with structural heart disease. J Am Coll Cardiol. 2003;41:81–92.

    CrossRef  Google Scholar 

  23. Di Biase L, Santangeli P, Burkhardt DJ, et al. Endo-epicardial homogenization of the scar versus limited substrate ablation for the treatment of electrical storms in patients with ischemic cardiomyopathy. J Am Coll Cardiol. 2012;60:132–41.

    CrossRef  Google Scholar 

  24. Di Biase L, Burkhardt JD, Lakkireddy D, et al. Ablation of stable VTs versus substrate ablation in ischemic cardiomyopathy: the VISTA randomized multicenter trial. J Am Coll Cardiol. 2015;66:2872–82.

    CrossRef  Google Scholar 

  25. Reddy VY, Reynolds MR, Neuzil P, et al. Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med. 2007;357:2657–65.

    CAS  CrossRef  Google Scholar 

  26. de Chillou C, Lacroix D, Klug D, et al. Isthmus characteristics of reentrant ventricular tachycardia after myocardial infarction. Circulation. 2002;105:726–31.

    CrossRef  Google Scholar 

  27. Pogwizd SM, Hoyt RH, Saffitz JE, et al. Reentrant and focal mechanisms underlying ventricular tachycardia in the human heart. Circulation. 1992;86:1872–87.

    CAS  CrossRef  Google Scholar 

  28. Kuck KH, Schaumann A, Eckardt L, et al. Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial. Lancet. 2010;375:31–40.

    CrossRef  Google Scholar 

  29. Kuck KH, Tilz RR, Deneke T, et al. Impact of substrate modification by catheter ablation on implantable cardioverter-defibrillator interventions in patients with unstable ventricular arrhythmias and coronary artery disease: results from the multicenter randomized controlled SMS (substrate modification study). Circ Arrhythm Electrophysiol. 2017;10:e004422.

    CrossRef  Google Scholar 

  30. Sapp JL, Wells GA, Parkash R, et al. Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs. N Engl J Med. 2016;375:111–21.

    CAS  CrossRef  Google Scholar 

  31. Jackson JA, Leake DR, Schneiders NJ, et al. Magnetic resonance imaging in multiple sclerosis: results in 32 cases. AJNR Am J Neuroradiol. 1985;6:171–6.

    CAS  PubMed  Google Scholar 

  32. Delacretaz E, Stevenson WG, Ellison KE, et al. Mapping and radiofrequency catheter ablation of the three types of sustained monomorphic ventricular tachycardia in nonischemic heart disease. J Cardiovasc Electrophysiol. 2000;11:11–7.

    CAS  CrossRef  Google Scholar 

  33. Oloriz T, Silberbauer J, Maccabelli G, et al. Catheter ablation of ventricular arrhythmia in nonischemic cardiomyopathy: anteroseptal versus inferolateral scar sub-types. Circ Arrhythm Electrophysiol. 2014;7:414–23.

    CrossRef  Google Scholar 

  34. Muser D, Santangeli P, Castro SA, et al. Long-term outcome after catheter ablation of ventricular tachycardia in patients with nonischemic dilated cardiomyopathy. Circ Arrhythm Electrophysiol. 2016;9:e004328.

    CAS  PubMed  Google Scholar 

  35. Gokoglan Y, Mohanty S, Gianni C, et al. Scar homogenization versus limited-substrate ablation in patients with nonischemic cardiomyopathy and ventricular tachycardia. J Am Coll Cardiol. 2016;68:1990–8.

    CrossRef  Google Scholar 

  36. Miljoen H, State S, de Chillou C, et al. Electroanatomic mapping characteristics of ventricular tachycardia in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia. Europace. 2005;7:516–24.

    CrossRef  Google Scholar 

  37. Yao Y, Zhang S, He DS, et al. Radiofrequency ablation of the ventricular tachycardia with arrhythmogenic right ventricular cardiomyopathy using non-contact mapping. Pacing Clin Electrophysiol. 2007;30:526–33.

    CrossRef  Google Scholar 

  38. Garcia FC, Bazan V, Zado ES, et al. Epicardial substrate and outcome with epicardial ablation of ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circulation. 2009;120:366–75.

    CrossRef  Google Scholar 

  39. Link MS, Bockstall K, Weinstock J, et al. Ventricular tachyarrhythmias in patients with hypertrophic cardiomyopathy and defibrillators: triggers, treatment, and implications. J Cardiovasc Electrophysiol. 2017;28:531–7.

    CrossRef  Google Scholar 

  40. Furushima H, Chinushi M, Iijima K, et al. Ventricular tachyarrhythmia associated with hypertrophic cardiomyopathy: incidence, prognosis, and relation to type of hypertrophy. J Cardiovasc Electrophysiol. 2010;21:991–9.

    CrossRef  Google Scholar 

  41. Dukkipati SR, D’Avila A, Soejima K, et al. Long-term outcomes of combined epicardial and endocardial ablation of monomorphic ventricular tachycardia related to hypertrophic cardiomyopathy. Circ Arrhythm Electrophysiol. 2011;4:185–94.

    CrossRef  Google Scholar 

  42. Santangeli P, Di Biase L, Lakkireddy D, et al. Radiofrequency catheter ablation of ventricular arrhythmias in patients with hypertrophic cardiomyopathy: safety and feasibility. Heart Rhythm. 2010;7:1036–42.

    CrossRef  Google Scholar 

  43. Furushima H, Chinushi M, Sugiura H, et al. Ventricular tachyarrhythmia associated with cardiac sarcoidosis: its mechanisms and outcome. Clin Cardiol. 2004;27:217–22.

    CrossRef  Google Scholar 

  44. Kumar S, Barbhaiya C, Nagashima K, et al. Ventricular tachycardia in cardiac sarcoidosis: characterization of ventricular substrate and outcomes of catheter ablation. Circ Arrhythm Electrophysiol. 2015;8:87–93.

    CrossRef  Google Scholar 

  45. Sarabanda AV, Sosa E, Simoes MV, et al. Ventricular tachycardia in Chagas’ disease: a comparison of clinical, angiographic, electrophysiologic and myocardial perfusion disturbances between patients presenting with either sustained or nonsustained forms. Int J Cardiol. 2005;102:9–19.

    CrossRef  Google Scholar 

  46. Scanavacca M, Sosa E. Epicardial ablation of ventricular tachycardia in Chagas heart disease. Card Electrophysiol Clin. 2010;2:55–67.

    CrossRef  Google Scholar 

  47. Proietti R, Roux JF, Essebag V. Recent advances in ablation of ventricular tachycardia associated with structural heart disease: overcoming the challenges of functional and fixed barriers. Curr Opin Cardiol. 2016;31:64–71.

    CrossRef  Google Scholar 

  48. Proietti R, Essebag V, Beardsall J, et al. Substrate-guided ablation of haemodynamically tolerated and untolerated ventricular tachycardia in patients with structural heart disease: effect of cardiomyopathy type and acute success on long-term outcome. Europace. 2015;17:461–7.

    CrossRef  Google Scholar 

Download references

Acknowledgments

We are indebted to Dr. Zhenhui Zhu from Fuwai Hospital for his echo data, Dr. Ivan Ho from Cedars-Sinai Medical Center for the VT data, and Miss Xiaodan Yang for the drafting of schematic diagram.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yan Yao .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Verify currency and authenticity via CrossMark

Cite this chapter

Ding, L., Yao, Y. (2019). Ventricular Tachycardia with Structural Heart Disease. In: Proietti, R., Wang, Y., Yao, Y., Zhong, G., Lin Wu, S., Ayala-Paredes, F. (eds) Cardiac Electrophysiology Without Fluoroscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-16992-3_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-16992-3_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16991-6

  • Online ISBN: 978-3-030-16992-3

  • eBook Packages: MedicineMedicine (R0)