2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: executive summary

Abstract

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

Genotype–phenotype correlation of LMNA variants involving the Arg541 residue: a case report with multimodality imaging and literature review

“…Given these results, a recent consensus document considered that VT ablation has only a palliative role in lamin cardiomyopathy. 10 By contrast, several features of the presented case depict a specific and atypical phenotype: (i) AV conduction was normal; (ii) scar distribution was not in the midwall of the septum but rather transmural, mainly apical and lateral and very extensive; (iii) severe regional LV wall thinning was present; and (iv) VT ablation was successful in controlling SMVTs.…”

Εlectrocardiographic and electrophysiological characteristics of idiopathic ventricular arrhythmias with acute successful ablation at the anterior portion of the mitral annulus

“…The ECGs were analyzed at a paper speed of 25 mm/s, and the signals were ampli ed at 10 mm/mV. VAs were analyzed for the following parameters: (1) The QRS amplitude in the inferior leads; (2) The QRS width; (3) The maximum de ection index (MDI), de ned as the duration from the earliest activation to the peak of the largest amplitude de ection divided by the total QRS duration, measured in the precordial leads; (4) The peak de ection index (PDI), de ned as the duration from the earliest activation to the peak of the largest amplitude de ection divided by the total QRS duration, measured in the inferior leads; (5) The S-wave in lead V 6 ; and (6) Inferior lead notching. All parameters were measured with electronic calipers by 3 experienced investigators blinded to the site of origin.…”

“…Most idiopathic ventricular arrhythmias (VAs), including idiopathic ventricular tachycardia (VT) and premature ventricular contractions (PVCs), have a right ventricular out ow tract (RVOT) or left ventricular out ow tract (LVOT) origin, but some may arise from various anatomical sites, including the right or left ventricular epicardial site, the aortic sinus cusp (ASC), the aortomitral continuity (AMC), around the anterior portion of the mitral annulus (AP-MA), and other sites [1]. Radiofrequency catheter ablation (RFCA) has emerged as a treatment for VAs, with a fairly high success rate.…”

Identification of the ventricular tachycardia circuit using the Advisor HD Grid multielectrode mapping catheter

“…Then, we mapped the VT circuit using the Advisor HD grid catheter and the EnSite One of 2 main strategies for dealing with life--threating arrhythmias represents mapping and ablation of the ventricular tachycardia (VT) circuit. 1 High -density mapping of the left ventricle using a dedicated multipolar catheter can provide a unique insight into both arrhythmia substrate and VT circuit. 2,3 The construction of the Advisor HD grid catheter (Abbott Medical, Abbott Park, Illinois, United States) allows for a highly detailed bipolar recording of myocardial electrical…”

“…Finally, modern multielectrode catheters enable us to easily merge multiple VT mapping techniques including activation mapping, substrate mapping, entrainment, and analysis of fractionated potentials in order to better understand the VT substrate and improve ablation outcomes. [1][2][3][4]…”