Abstract
It is critical to begin any discussion on ablation of unstable ventricular tachycardia with background information supporting the importance of the effort. First, stable, mappable ventricular tachycardias represent the tip of the arrhythmia iceberg. In order for any arrhythmia to be mappable it must be reliably inducible and hemodynamically tolerable. The ventricular tachycardia must also be stable in response to the catheter manipulation and pacing required to identify the appropriate site for ablative therapy during activation and entrainment mapping [1–4]. In a consecutive series of “ideal” patients presenting with hemodynamically tolerated ventricular tachycardia and referred for catheter ablation, 30% had only unmappable VT at the time of electrophysiological evaluation [5]. Secondly, ICD event monitoring after device implantation has documented rapid unmappable VT in most patients regardless of the clinical indication for initial device therapy [6–8]. Finally, in looking to the future, a strategy for prevention of sudden cardiac death that uses ablative therapy must target the substrate for unmappable ventricular tachycardia [9].
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References
El-Shalakany A, Hadjis T, Papageorgiou P et al (1999) Entrainment/mapping criteria for the prediction of termination of ventricular tachycardia by single radiofrequency lesion in patients with coronary artery disease. Circulation 99:2283–2289
Stevenson WG, Khan H, Sager P et al (1993) Identification of reentry circuit sites during catheter mapping and radiofrequency ablation of VT late after myocardial infarction. Circulation 88:1647–1670
Marchlinski FE, Gottlieb CD, Callans DJ et al (1997) Ablative therapy for VT in the setting of chronic coronary artery disease. In: Ellenbogen K, Epstein A (eds) Sudden cardiac death: past, present and future. Futura, Armonk, pp 199–224
Rothman SA, Hsia HH, Cossü SF et al (1997) Radiofrequency catheter ablation of postinfarction VT. Long term success and the significance of inducible nonclinical arrhythmias. Circulation 96:3499–3508
Callans DJ, Zado E, Sarter BH, Schwartzman D, Gottlieb CD, Marchlinski FE (1998) Procedural efficacy of radiofrequency ablation for ventricular tachycardia in patients with healed myocardial infarction: an intention to treat analysis. Am J Cardiol 82:429–432.
Marchlinski FE, Saligan JRP, Reddy T, Movsowitz C, Menz V ( 1994) Stored diagnostic information in implantable cardioverter defibrillators: optimum recording techniques and duration. In: Santini M (ed) Progress in clinical pacing. Futura Publishing, Rome, pp 89–108
Marchlinski FE, Gottlieb CD Schwartzman D, Gonzalez-Zuelgaray J, Callans DJ (1995) Electrical events associated with ventricular tachycardia initiation and their prevention. In: Zipes DP, Jalife J (eds) Cardiac electrophysiology from cell to bedside, 2nd edn. Saunders, Philadelphia, 863–877
Russo AM, Dixit S, Verdino R et al (2003) Frequency and timing of defibrillator events in patients without documented arrhythmias: who is at highest risk? J Am Coll Cardiol 41:137A
Alonso C, Lin D, Poku J et al (2003) The role of transcatheter ablation in the prevention of sudden death. In: Santini M (ed) Sudden death-nonpharmacological treatment. Arianna Editrice, France (in press)
Marchlinski FE, Buxton AE, Kindwall KE et al (1988) Comparison of individual and combined effects of procainamide and amiodarone in patients with sustained ventricular tachyarrhythmias. Circulation 78:583–591
Grimm W, Cho JG, Marchlinski FE (1994) Effects of incremental doses of procainamide in patients with sustained uniform ventricular tachycardia. J Card Electrophysiol 5:313–322
Schalij MK, Van Rugge FP, Siezenga M et al (1998) Endocardial activation mapping of ventricular tachycardia in patients: first application of a 32-site bipolar mapping electrode catheter. Circulation 98:2168–2179
Strickberger SA, Knight BP, Michaud GF et al (2000) Mapping and ablation of ventricular tachycardia guided by virtual electrograms using a noncontact, computerized mapping system. J Am Coll Cardiol 35:414–421
Shilling RJ, Peters NS, Davies DW (1999) Feasibility of a noncontact catheter for endocardial mapping of human ventricular tachycardia. Circulation 99:2543–2552
Aoyama H, Nakagawa H, Baltazar de Castro et al (2003) Accuracy of noncontact mapping in identifying lines of conduction block as a function of distance (abstract). J Am Coll Cardiol 41:19A abs 1042
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 101:1288–1296
Marchlinski FE, Callans DJ, Zado ES et al (2002) Approach to unstable ventricular tachycardia. In: Schalij MJ, Janse MJ, van Oosterom A, Wellens HJJ, van der Wall EE (eds) Einthoven 2002: 100 years of electrocardiography. The Einthoven Foundation, Leiden, pp 75–85
Marchlinski FE, Josephson ME (1987) Surgical treatment of ventricular tachyarrhythmias. In: Platia EV (ed) Non-pharmacologic management of cardiac arrhythmias, chap 15. Lippincott, Philadelphia, pp 340–363
Couch OA (1959) Cardiac aneurysm with VT and subsequent excision of aneurysm. Circulation 20:251–253
Horowitz LN, Harken AH, Kastor JA, Josephson ME (1980) Ventricular resection guided by epicardial and endocardial mapping for treatment of recurrent VT. N Engl J Med 302:589–593
Moran JM, Kehoe RH, Loeb JM et al (1982) Extended endocardial resection for the treatment of VT and ventricular fibrillation. Ann Thorac Surg 34:538–552
Hargrove WC, Miller JM, Vassallo JA, Josephson ME (1986) Improved results in the operative management of VT related to inferior wall infarction: importance of the annular isthmus. J Thorac Cardiovasc Surg 92:726–732
Shpun S, Gepstein L, Hayam G, Ben-Haim SA (1997) Guidance of radiofrequency endocardial ablation with real-time three-dimensional magnetic navigation system. Circulation 96:2016–2021
Gepstein L, Hayam G, Ben-Haim SA (1997) A novel method for nonfluoroscopic catheter-based electroanatomical mapping of the heart. In vitro and in vivo accuracy results. Circulation 95:1611–1622
Marchlinski F, Callans D, Gottlieb C et al (1998) Magnetic electroanatomical mapping for ablation of focal atrial tachycardias. Pacing Clin Electrophysiol 21:1621–1635
Marchlinski FE, Callans DJ, Russo AM et al (2000) Normal ventricular electrogram signal amplitude using magnetic electroanatomic mapping influence of recording polarity and mapped chamber (abstract). J Am Coll Cardiol 35:120A
Hsia HH, Callans DJ, Marchlinski FE (2003) Characterization of endocardial electrophysiologic substrate in patients presenting with non-ischemic cardiomyopathy and monomorphic ventricular tachycardia. Circulation (in press)
Josephson ME, Waxman HL, Cain ME, Gardner MJ, Buxton AE (1982) Ventricular activation during ventricular endocardial pacing. II. Role of pace-mapping to localize the origin of VT. Am J Cardiol 50:11–22
Miller JM, Marchlinski FE, Buxton AE, Josephson ME (1988) Relationship between the 12-lead electrocardiogram during VT and endocardial site of origin inpatients with coronary artery disease. Circulation 77:759–766
Dixit S, Gerstenfeld EP, Callans DJ, Marchlinski FE (2003) Electro cardiographic patterns of superior right ventricular outflow tract tachycardias: distinguishing septal and free wall sites of origin. J Cardiovasc Electrophysiol 14:1–7
Calkins H, Epstein A, Packer D et al (2000) Catheter ablation of ventricular tachycardia in patients with structural heart disease using cooled radiofrequency energy. Results of a prospective multicenter study. J Am Coll Cardiol 35:1905–1914
Marchlinski FE, Callans DJ, Hsia HH et al (2001) Late outcome after linear radiofrequency ablation for unmappable ventricular tachycardia: influence of type of heart disease. Circulation 104(17):II-621
Soejima K, Suzuki M, Maisel WH et al (2001) 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 104:664–669
Marchlinski FE, Rose G, Kleiman R, Callans D, Hanna M (1993) Sudden death in nonischemic cardiomyopathy. In: Josephson ME (ed) Sudden cardiac death. Blackwell Scientific, Cambridge Mass, pp 383–396
Hsia HH, Marchlinski FE (2002) Characterization of the electroanatomic substrate for monomorphic ventricular tachycardia in patients with nonischemic cardiomyopathy. Pacing Clin Electrophysiol 25:1114–1127
Sosa E, Scanavacca M, D’Avila A, Pilleggi F (1996) A new technique to perform epicardial mapping in the in the electrophysiology laboratory. J Cardiovasc Electrophysiol 7:531–536
Sosa E, Scanavacca M, D’Avila A et al (2000) Nonsurgical transthoracic epicardial catheter ablation to treat recurrent ventricular tachycardia occurring late after myocardial infarction. J Am Coll Cardiol 35:1442–1449
Dixit S, Narula N, Callans DJ, Marchlinski FE (2003) Electro-anatomic mapping of human heart: epicardial fat masquerading as scar. J Cardiovasc Electrophysiol (in press)
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Marchlinski, F.E. et al. (2004). Ablation of Unstable Ventricular Tachycardia. In: Raviele, A. (eds) Cardiac Arrhythmias 2003. Springer, Milano. https://doi.org/10.1007/978-88-470-2137-2_58
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DOI: https://doi.org/10.1007/978-88-470-2137-2_58
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