Steven Daniel, van den Bruck Jan-Hendrik, Lüker Jakob, Plenge Tobias, Sultan Arian
Abt. für Elektrophysiologie, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
Herzschrittmacherther Elektrophysiol. 2017 Jun;28(2):206-211. doi: 10.1007/s00399-017-0511-5.
Catheter ablation of ventricular tachycardia (VT) is gaining in importance. The current guidelines suggest considering catheter ablation for VT even in patients with a single sustained and documented episode. This is also underlined by recent data indicating that absence of VT predicts lower mortality and longer transplant-free survival. The majority of patients with VTs have a history of prior myocardial infarction; in a smaller proportion, patients present with dilated cardiomyopathy. The latter has a less structured scar pattern which makes it more complicated to apply efficient ablation strategies. Data have shown that the probability of VT recurrence after catheter ablation is higher and an epicardial access more frequently required. Algorithms and strategies to improve catheter ablation results have been developed and evaluated especially on patients with dilated cardiomyopathy (DCM) to further improve outcomes. The present article will strive to acquaint the reader with the current strategies and state of knowledge.
室性心动过速(VT)的导管消融正变得越来越重要。当前指南建议,即使是仅有一次持续性且记录在案的室性心动过速发作的患者,也应考虑进行导管消融。近期数据也强调了这一点,这些数据表明无室性心动过速预示着更低的死亡率和更长的无移植生存期。大多数室性心动过速患者有既往心肌梗死病史;在较小比例的患者中,表现为扩张型心肌病。后者的瘢痕模式不太规整,这使得应用有效的消融策略更加复杂。数据显示,导管消融后室性心动过速复发的可能性更高,且更常需要心外膜入路。已经开发并评估了改善导管消融结果的算法和策略,尤其是针对扩张型心肌病(DCM)患者,以进一步改善治疗效果。本文将努力使读者了解当前的策略和知识状态。