Muser Daniele, Lavalle Carlo, Guarracini Fabrizio, Sassone Biagio, Conte Edoardo, Magnani Silvia, Notarstefano Pasquale, Barbato Gaetano, Sgarito Giuseppe, Grandinetti Giuseppe, Nucifora Gaetano, Ricci Renato P, Boriani Giuseppe, De Ponti Roberto, Casella Michela
Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Pennsylvania, USA.
Cardiology Division, Santa Maria della Misericordia Hospital, Udine.
J Cardiovasc Med (Hagerstown). 2021 Oct 1;22(10):727-737. doi: 10.2459/JCM.0000000000001121.
Ventricular tachycardia is a major health issue in patients with structural heart disease (SHD). Implantable cardioverter defibrillator (ICD) therapy has significantly reduced the risk of sudden cardiac death (SCD) in such patients, but on the other hand, it has led to frequent ICD shocks as an emerging problem, being associated with poor quality of life, frequent hospitalizations and increased mortality. Myocardial scar plays a central role in the genesis and maintenance of re-entrant arrhythmias, as the coexistence of surviving myocardial fibres within fibrotic tissue leads to the formation of slow conduction pathways and to a dispersion of activation and refractoriness that constitutes the milieu for ventricular tachycardia circuits. Catheter ablation has repeatedly proven to be well tolerated and highly effective in treating VT and in the last two decades has benefited from continuous efforts to determine ventricular tachycardia mechanisms by integration with a wide range of invasive and noninvasive imaging techniques such as intracardiac echocardiography, cardiac magnetic resonance, multidetector computed tomography and nuclear imaging. Cardiovascular imaging has become a fundamental aid in planning and guiding catheter ablation procedures by integrating structural and electrophysiological information, enabling the ventricular tachycardia arrhythmogenic substrate to be characterized and effective ablation targets to be identified with increasing precision, and allowing the development of new ablation strategies with improved outcomes. In this review, we provide an overview of the role of cardiac imaging in patients undergoing catheter ablation of ventricular tachycardia.
室性心动过速是结构性心脏病（SHD）患者的一个主要健康问题。植入式心脏复律除颤器（ICD）治疗显著降低了此类患者心源性猝死（SCD）的风险，但另一方面，它导致了频繁的ICD电击这一新兴问题，与生活质量差、频繁住院和死亡率增加相关。心肌瘢痕在折返性心律失常的发生和维持中起核心作用，因为纤维化组织中存活心肌纤维的共存导致了缓慢传导通路的形成以及激活和不应期的离散，这构成了室性心动过速环路的环境。导管消融已多次被证明在治疗室性心动过速方面耐受性良好且非常有效，在过去二十年中受益于通过与多种有创和无创成像技术（如心腔内超声心动图、心脏磁共振、多排螺旋计算机断层扫描和核成像）相结合来确定室性心动过速机制的持续努力。心血管成像通过整合结构和电生理信息，已成为规划和指导导管消融手术的重要辅助手段，能够越来越精确地对室性心动过速的致心律失常基质进行表征并识别有效的消融靶点，并允许开发具有更好结果的新消融策略。在本综述中，我们概述了心脏成像在接受室性心动过速导管消融患者中的作用。
