The use of various approaches in the treatment of ventricular arrhythmias

Authors: Avanesyan G.A., Filatov A.G., Temirbulatov I.A.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Reviews


DOI: https://doi.org/10.24022/1997-3187-2024-18-2-164-175

For citation: Avanesyan G.A., Filatov A.G., Temirbulatov I.A. The use of various approaches in the treatment of ventricular arrhythmias. Creative Cardiology. 2024; 18 (2): 164–175 (in Russ.). DOI: 10.24022/1997-3187-2024-18-2-164-175

Received / Accepted:  25.01.2024 / 29.03.2024

Keywords: ventricular arrhythmias radiofrequency ablation non-fluoroscopic mapping



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Abstract

Ventricular tachyarrhythmias (VT) are the most difficult problem in arrhythmology due to the fact that they are associated with a high risk of sudden cardiac death (SCD). In 85% of cases, the development of SCD is due to ventricular tachycardia and ventricular fibrillation. The vast majority (up to 80%) of ventricular arrhythmias occur in patients with atherosclerotic lesions of the coronary arteries, while more than half of VT occur in patients who have had myocardial infarction. In addition, ventricular arrhythmias are difficult to surgical and/or interventional treatment, which in turn encourages most scientists to look for ways to increase the effectiveness of treatment in this group of patients. The main purpose of this review is to describe various approaches in the interventional treatment of ventricular arrhythmias.

References

  1. Lebedev D.S., Mikhailov E.N., Neminushchiy N.M., Golukhova E.Z., Babokin V.E., Bereznitskaya V.V. et al. Ventricular arrhythmias. Ventricular tachycardias and sudden cardiac death. 2020 Clinical guidelines. Russian Journal of Cardiology. 2021; 26 (7): 4600 (in Russ.). DOI: 10.15829/1560-4071-2021-4600
  2. Priori S.G., Blomström-Lundqvist C., Mazzanti A., Blom N., Borggrefe M., Camm J. et al. ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death 2015. Russian Journal of Cardiology. 2016; 7 (135): 5–86 (in Russ.). DOI: 10.15829/1560-4071-2016-7-5-86
  3. Korolev S.V., Artyukhina E.A., Shabanov V.V., Sapelnikov O.V., Tsyganov A.V., Revishvili A.Sh., Romanov A.B. High-power radiofrequency ablation in the treatment of ventricular tachycardia in patients with structural heart pathology: results of one year of observation of a multicenter prospective registry. Circulation Pathology and Cardiac Surgery (Patologiya Krovoobrashcheniya i Kardiokhirurgiya). 2023; 27 (2): 66–73 (in Russ.). DOI: 10.21688/1681-3472-2023-2-66-73
  4. Yeghiazarians Y., Jneid H., Tietjens J.R. et al. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021; 144: e56–e67. DOI: 10.1161/CIR.0000000000000988
  5. Bessière F., Waldmann V., Combes N., Metton O., Dib N., Mondésert B. et al. Ventricular arrhythmias in adults with congenital heart disease, part II: JACC State-of-the-Art Review. J. Am. Coll. Cardiol. 2023; 82 (11): 1121–1130. DOI: 10.1016/j. jacc.2023.06.036
  6. Martinez B.K., Baker W.L., Konopka A., Giannelli D., Coleman C.I., Kluger J., Cronin E.M. Systematic review and meta- analysis of catheter ablation of ventricular tachycardia in ischemic heart disease. Heart Rhythm. 2020; 17: e206–e219. DOI: 10.1016/j.hrthm.2019.04.024
  7. Jaïs P., Maury P., Khairy P., Sacher F., Nault I., Komatsu Y. et al. Elimination of local abnormal ventricular activities: a new end point for substrate modification in patients with scar-related ventricular tachycardia. Circulation. 2012; 125 (18): 2184–2196. DOI: 10.1161/CIRCULATIONAHA.111.043216
  8. Vicera J.J.B., Lin Y.J., Lee P.T., Chang S.L., Lo L.W., Hu Y.F. et al. Identification of critical isthmus using coherent mapping in patients with scar-related atrial tachycardia. J. Cardiovasc. Electrophysiol. 2020; 31 (6): 1436–1447. DOI: 10.1111/jce.14457
  9. Guckel D., Molatta S., Imnadze G., Bergau L., Sommer P., Sohns C. Coherent-Mapping bei angeborenen Herzfehlern. Herzschrittmacherther. Elektrophysiol. 2021; 32 (1): 119–123. DOI: 10.1007/s00399-020-00733-4
  10. Wolf M., Sacher F., Cochet H., Kitamura T., Takigawa M., Yamashita S. et al. Long-term outcome of substrate modification in ablation of post-myocardial infarction ventricular tachycardia. Circulation. Arrhythm. Electrophysiol. 2018; 11 (2): e005635. DOI: 10.1161/CIRCEP.117.005635
  11. Sacher F., Lim H.S., Derval N., Denis A., Berte B., Yamashita S. et al. Substrate mapping and ablation for ventricular tachycardia: the LAVA approach. J. Cardiovasc. Electrophysiol. 2015; 26 (4): 464–471. DOI: 10.1111/jce.12565
  12. Reddy V.Y., Reynolds M.R., Neuzil P., Richardson A.W., Taborsky M., Jongnarangsin K. et al. Prophylactic catheter ablation for the prevention of defibrillator therapy. New Engl. J. Med. 2007; 357 (26): 2657–2665. DOI: 10.1056/NEJMoa065457
  13. Sciacca V., Fink T., Bergau L., Imnadze G., El Hamriti M., Guckel D. et al. Combination of high-density and coherent mapping for ablation of ventricular arrhythmia in patients with structural heart disease. J. Clin. Med. 2022; 11 (9): 2418. DOI: 10.3390/jcm11092418
  14. Marchlinski F.E., Callans D.J., Gottlieb C.D., Zado E. Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy. Circulation. 2000; 101 (11): 1288–1296. DOI: 10.1161/01.cir.101.11.1288
  15. Soejima K., Suzuki M., Maisel W.H., Brunckhorst C.B., Delacretaz E., Blier L. et al. 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. 2001; 104 (6): 664–669. DOI: 10.1161/hc3101.093764
  16. Reddy V.Y., Reynolds M.R., Neuzil P., Richardson A.W., Taborsky M., Jongnarangsin K. et al. Prophylactic catheter ablation for the prevention of defibrillator therapy. New Engl. J. Med. 2007; 357 (26): 2657–2665. DOI: 10.1056/NEJMoa065457
  17. Korolev S.V., Artyukhina E.A., Shabanov V.V., Sapelʹnikov O.V., Tsyganov A.V., Revishvili A.SH., Romanov A.B. Comparative assessment of the results of a prospective register of radiofrequency ablation of high power ventricular arrhythmias in patients with coronary heart disease. Bulletin of Pirogov National Medical & Surgical Center. 2023; 18 (1): 28–35 (in Russ.). DOI 10.25881/20728255_2023_18_1_28
  18. Tung R., Josephson M.E., Reddy V., Reynolds M.R. Influence of clinical and procedural predictors on ventricular tachycardia ablation outcomes: an analysis from the substrate mapping and ablation in Sinus Rhythm to Halt Ventricular Tachycardia Trial (SMASH-VT). J. Cardiovasc. Electrophysiol. 2010; 21 (7): 799–803. DOI: 10.1111/j.1540-8167.2009.01705.x
  19. Magtibay K., Massé S., Niri A., Anderson R.D., Kumar R.B., Deno D.C., Nanthakumar K. Maximizing detection and optimal characterization of local abnormal ventricular activity in nonischemic cardiomyopathy: LAVAMAX & LAVAFLOW. Heart Rhythm O2. 2021; 2 (5): 529–536. DOI: 10.1016/j.hroo.2021.08.006
  20. Arenal A., Glez-Torrecilla E., Ortiz M., Villacastín J., Fdez-Portales J., Sousa E. et al. Ablation of electrograms with an isolated, delayed component as treatment of unmappable monomorphic ventricular tachycardias in patients with structural heart disease. J. Am. Coll. Cardiol. 2003; 41 (1): 81–92. DOI: 10.1016/s0735-1097(02)02623-2
  21. Volkmer M., Ouyang F., Deger F., Ernst S., Goya M., Bänsch D. et al. Substrate mapping vs. tachycardia mapping using CARTO in patients with coronary artery disease and ventricular tachycardia: impact on outcome of catheter ablation. EP Europace. 2006; 8 (11): 968–976. DOI: 10.1093/europace/eul109
  22. Nogami A., Sugiyasu A., Tada H., Kurosaki K., Sakamaki M., Kowase S. et al. Changes in the isolated delayed component as an endpoint of catheter ablation in arrhythmogenic right ventricular cardiomyopathy: predictor for long-term success. J. Cardiovasc. Electrophysiol. 2008; 19 (7): 681–688. DOI: 10.1111/j.1540-8167.2008.01104.x
  23. Gasimova N.Z., Shabanov V.V., Safonov N.V., Rzayev F.G., Filatov A.G., Rogalev P.V. et al. Multipolar mapping in the management of different arrhythmias. Journal of Arrhythmology. 2024; 31 (1): 110–122 (in Russ.). DOI: 10.35336/VA-1297
  24. Di Biase L., Santangeli P., Burkhardt D.J., Bai R., Mohanty P., Carbucicchio C. et al. Endo-epicardial homogenization of the scar versus limited substrate ablation for the treatment of electrical storms in patients with ischemic cardiomyopathy. J. Am. Coll. Cardiol. 2012; 60 (2): 132–141. DOI: 10.1016/j.jacc.2012.03.044
  25. Soejima K., Stevenson W.G., Maisel W.H., Sapp J.L., Epstein L.M. Electrically unexcitable scar mapping based on pacing threshold for identification of the reentry circuit isthmus: feasibility for guiding ventricular tachycardia ablation. Circulation. 2002; 106 (13): 1678–1683. DOI: 10.1161/01.cir.0000030187.39852.a7
  26. A Arenal A., del Castillo S., Gonzalez-Torrecilla E., Atienza F., Ortiz M., Jimenez J., Puchol A. et al. Tachycardia-related channel in the scar tissue in patients with sustained monomorphic ventricular tachycardias: influence of the voltage scar definition. Circulation. 2004; 110 (17): 2568–2574. DOI: 10.1161/01.CIR.0000145544.35565.47

About Authors

  • Grayr A. Avanesyan, Cardiovascular Surgeon; ORCID
  • Andrey G. Filatov, Dr. Med. Sci., Head of Department; ORCID
  • Ibragim A. Temirbulatov, Cardiovascular Surgeon; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery