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Cardiac Sympathetic Innervation and Ablation of Ventricular Tachycardia

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Atlas of Cardiac Innervation

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Abstract

The cornerstone of current techniques for identifying successful ablation sites of ventricular tachyarrhythmias in patients with structural heart disease is the localization of abnormal or scarred myocardium. This tissue usually contains areas of slow conduction, which are critical for maintaining reentrant arrhythmias. Electroanatomic mapping performed in the electrophysiology laboratory identifies the presence of anatomic scar by decreased bipolar voltages measured with roving, steerable catheters. Given the inherent limitations of this technique, such as falsely low voltage recording due to poor catheter contact, the inability to detect intramural scar, and limited mapping density, imaging modalities such magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), and single photon emission computed tomography have been used to assess scar by demonstrating gadolinium enhancement, thinned walls, and perfusion/metabolic abnormalities. However, the recurrence rate in multicenter trials using state-of-the-art technology is close to 50 % in the first 6 months after ventricular tachycardia (VT) ablation.

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Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    John T. Duell MD

  2. Providence Sacred Heart Medical Center, Department of Medicine, Spokane, WA, USA

    Thomas Klein MD

  3. Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    Mark F. Smith PhD & Wengen Chen MD, PhD

  4. Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    Vasken Dilsizian MD

  5. Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    Timm Dickfeld MD, PhD

Authors
  1. John T. Duell MD
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  2. Thomas Klein MD
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  3. Mark F. Smith PhD
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  4. Wengen Chen MD, PhD
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  5. Vasken Dilsizian MD
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  6. Timm Dickfeld MD, PhD
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Corresponding author

Correspondence to John T. Duell MD .

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Editors and Affiliations

  1. Division of Nuclear Medicine Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, Maryland, USA

    Vasken Dilsizian

  2. Division of Cardiology, Mount Sinai Medical Center, New York, New York, USA

    Jagat Narula

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Duell, J.T., Klein, T., Smith, M.F., Chen, W., Dilsizian, V., Dickfeld, T. (2017). Cardiac Sympathetic Innervation and Ablation of Ventricular Tachycardia. In: Dilsizian, V., Narula, J. (eds) Atlas of Cardiac Innervation. Springer, Cham. https://doi.org/10.1007/978-3-319-45800-7_8

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  • DOI: https://doi.org/10.1007/978-3-319-45800-7_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-45798-7

  • Online ISBN: 978-3-319-45800-7

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