Editorial: Modern treatment of ventricular arrhythmias

Abstract

Editorial on the Research Topic Modern treatment of ventricular arrhythmiasVentricular arrhythmias (VA) encompass a wide spectrum of clinical conditions, ranging from benign conditions, such as isolated ectopic beats in patients without structural heart disease, to life-threatening emergencies, such as electrical storms in patients with very advanced structural heart disease. Owing to the great variety of clinical conditions, pathophysiological mechanisms, and therapeutic approaches, VA have been the focus of a thriving body of literature.A bibliometric analysis by Wang S. et al., presented in this special issue, shows that in the last 20 years, ∼7,000 papers have been published about VA, with "catheter ablation" being one of the main topics. A large amount of research contributed to the latest update of European guidelines on VA and sudden death (1), where catheter ablation earned quite a high number of class I and IIa indications, thanks to technological advances driving important results of clinical trials.Catheter ablation may also be curative in clinical situations that are challenging for both clinical and anatomical issues. Jiang et al. provide us with data from a pediatric cohort of 6 patients aged 8.4 years, ±2.6 years, presenting with VA originating from the moderator band of the right ventricle. This paper enriches this special issue, representing a good example of how catheter ablation could also be effective in this insidious condition typical of young patients with VA originating in a difficult to access anatomical area. Access to catheter ablation is often limited by patients' hemodynamic instability, either due to the high number of arrhythmias or to the extent of left ventricular dysfunction. In this regard, the use of the PAINESD score has been proposed to identify patients more likely to be at risk of hemodynamic collapse during the procedure (2). According to this score, which is measured from 0 to 36 points, patients scoring more than 17 points showed a 24% risk of acute hemodynamic decompensation. Additionally, acute hemodynamic decompensation during the procedure was associated with a worse prognosis in the short-term. For these patients a mechanical circulatory support may be useful to maintain a good perfusion during catheter ablation and also to help with procedure-related complications.