Proietti Riccardo, Roux Jean-François, Essebag Vidal
aMcGill University Health Center bCardiology Division, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke cHôpital Sacré-Coeur de Montreál, Montreal, Quebec, Canada dCardiology Department, Luigi Sacco Hospital, Milan, Italy.
Curr Opin Cardiol. 2016 Jan;31(1):64-71. doi: 10.1097/HCO.0000000000000242.
Ablation of ventricular tachycardia in structural heart disease has evolved to include techniques to ablate the myocardial substrate in sinus rhythm for ventricular tachycardias that are noninducible or hemodynamically unstable. The intricacies of the complex functional and fixed components of the myocardial scar involved in the arrhythmic mechanisms require careful consideration in identifying targets for substrate ablation identified in sinus rhythm.
The substrate ablation approach referred to as 'scar homogenization' aims to thoroughly abolish any abnormal electrical activity inside the scar. However, this extensive approach may target bystander abnormal activity that is not necessarily related to arrhythmias. Recently, different substrate ablation strategies have been developed to more selectively target areas of the scar responsible for ventricular tachycardia. New technologies have also been introduced to provide offline analysis of the electroanatomical substrate, and to improve high-density mapping of the myocardial scar.
Recent advances have improved the ability to ablate ventricular tachycardia using techniques that allow targeting the responsible myocardial substrate while in sinus rhythm. Further research using higher-density mapping with more sophisticated online and offline analysis will aid in the assessment of the complex arrhythmogenicity of the scar and improve efficacy of ventricular tachycardia ablation.
结构性心脏病室性心动过速的消融治疗已发展为包括在窦性心律下对不可诱发或血流动力学不稳定的室性心动过速进行心肌基质消融的技术。心律失常机制中涉及的心肌瘢痕复杂功能和固定成分的复杂性，在确定窦性心律下基质消融靶点时需要仔细考虑。
被称为“瘢痕均质化”的基质消融方法旨在彻底消除瘢痕内的任何异常电活动。然而，这种广泛的方法可能针对不一定与心律失常相关的旁观者异常活动。最近，已开发出不同的基质消融策略，以更有选择性地针对导致室性心动过速的瘢痕区域。还引入了新技术，以提供对电解剖基质的离线分析，并改善心肌瘢痕的高密度标测。
最近的进展提高了在窦性心律下使用能够靶向责任心肌基质的技术消融室性心动过速的能力。使用更复杂的在线和离线分析进行更高密度标测的进一步研究将有助于评估瘢痕复杂的致心律失常性，并提高室性心动过速消融的疗效。
