Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA, Leiden, The Netherlands.
Europace. 2019 Mar 1;21(3):383-403. doi: 10.1093/europace/euy150.
Over the last decades, substrate-based approaches to ventricular tachycardia (VT) ablation have evolved into an important therapeutic option for patients with various structural heart diseases (SHD) and unmappable VT. The well-recognized limitations of conventional electroanatomical mapping (EAM) to delineate the complex 3D architecture of scar, and the potential capability of advanced cardiac imaging technologies to provide adjunctive information, have stimulated electrophysiologists to evaluate the role of imaging to improve safety and efficacy of catheter ablation. In this review, we summarize the histological differences between SHD aetiologies related to monomorphic sustained VT and the currently available data on the histological validation of cardiac imaging modalities and EAM to delineate scar and the arrhythmogenic substrate. We review the current evidence of the value provided by cardiac imaging to facilitate VT ablation and to ultimately improve outcome.
在过去的几十年中，基于基质的室性心动过速（VT）消融方法已经发展成为各种结构性心脏病（SHD）和不可标测 VT 患者的重要治疗选择。传统的电解剖标测（EAM）在描绘瘢痕的复杂 3D 结构方面存在明显的局限性，以及先进的心脏成像技术在提供辅助信息方面的潜在能力，激发了电生理学家评估成像在提高导管消融安全性和疗效方面的作用。在这篇综述中，我们总结了与单形性持续性 VT 相关的 SHD 病因之间的组织学差异，以及目前关于心脏成像方式和 EAM 来描绘瘢痕和心律失常基质的组织学验证的现有数据。我们回顾了心脏成像在促进 VT 消融并最终改善预后方面提供的价值的现有证据。
