VT ablation: New Developments and Approaches

A novel ECG finding in patients with epicardial infarct-associated ventricular tachycardia: a case series

OBJECTIVES

This study analyzes the incidence, characteristics, and ECG morphology of ventricular tachycardia (VT) in post-infarction patients undergoing epicardial VT ablation.

BACKGROUND

Ablation of recurrent VTs in patients with ischemic cardiomyopathy is typically performed endocardially. In rare cases, epicardial access is required to achieve non-inducibility.

METHODS AND RESULTS

The study evaluated the baseline characteristics, procedural data, and ECG morphology of clinical VT in patients undergoing epicardial VT ablation. From the initial 491 patients with coronary heart disease (CHD) and recurrent VTs undergoing ablation at the Heart Center of Leipzig, Germany, between 2012 and 2020, only 39 patients required an additional epicardial access. In 17 patients, the VTs were associated with infarction scar, while the remaining patients had concomitant CHD without infarction-associated scar and were excluded from the analysis. A propensity match study was performed at a 1:2 ratio for these 17 patients, with 34 patients of the initial cohort as a control group to evaluate the differences in baseline characteristics, procedural data, and ECG morphology of the VTs. The specific VT morphology of negative concordance and superior axis in patients with inferior scar as well as the history of VT ablation were independent predictors of the need for epicardial access.

CONCLUSIONS

In addition to previous endocardial ablation, VT ECG morphology with negative concordance and superior axis in post-infarction patients with inferior scar predicted the need for epicardial VT ablation.

Catheter ablation in the treatment of electrical storm: Integrative review

BACKGROUND

The incidence of electrical storm (ES) has been increasing with the rise of the indicated uses of implantable cardioverter defibrillators (ICDs). It is estimated that 20% of patients will evolve to have this complication. Ablative therapy stands out as the treatment for this condition when it is refractory to antiarrhythmic treatment. The objective was to define the current role of catheter ablation in the treatment of electrical storm.

METHODS

An integrative literature review was performed using the PubMed and BVS databases. All identified articles were screened and verified for eligibility by the authors.

RESULTS

Twenty-five out of the initial 951 articles were used in the final analysis. The categories listed for analysis included indication for ablation in ES, modality of the approach, therapeutic success, complications related to the procedure, mortality and cardiovascular follow-up and alternative therapeutic modalities by frequency of these categories in the articles researched.

CONCLUSION

Catheter ablation is the initial therapy for patients with ischemic cardiomyopathy (ICM) and ES. The endocardial approach presents more relevant success rates than the other therapeutic methods presented.