Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA.
J Interv Card Electrophysiol. 2023 Sep;66(6):1499-1518. doi: 10.1007/s10840-022-01311-z. Epub 2022 Jul 25.
Catheter ablation of ventricular arrhythmias (VAs) has evolved significantly over the past decade and is currently a well-established therapeutic option. Technological advances and improved understanding of VA mechanisms have led to tremendous innovations in VA ablation. The purpose of this review article is to provide an overview of current innovations in VA ablation. Mapping techniques, such as ultra-high density mapping, isochronal late activation mapping, and ripple mapping, have provided improved arrhythmogenic substrate delineation and potential procedural success while limiting duration of ablation procedure and potential hemodynamic compromise. Besides, more advanced mapping and ablation techniques such as epicardial and intramyocardial ablation approaches have allowed operators to more precisely target arrhythmogenic substrate. Moreover, advances in alternate energy sources, such as electroporation, as well as stereotactic radiation therapy have been proposed to be effective and safe. New catheters, such as the lattice and the saline-enhanced radiofrequency catheters, have been designed to provide deeper and more durable tissue ablation lesions compared to conventional catheters. Contact force optimization and baseline impedance modulation are important tools to optimize VT radiofrequency ablation and improve procedural success. Furthermore, advances in cardiac imaging, specifically cardiac MRI, have great potential in identifying arrhythmogenic substrate and evaluating ablation success. Overall, VA ablation has undergone significant advances over the past years. Innovations in VA mapping techniques, alternate energy source, new catheters, and utilization of cardiac imaging have great potential to improve overall procedural safety, hemodynamic stability, and procedural success.
过去十年，导管消融治疗室性心律失常（VA）取得了显著进展，目前已成为一种成熟的治疗选择。技术进步和对 VA 机制的深入理解推动了 VA 消融领域的巨大创新。本文旨在概述 VA 消融领域的最新创新。映射技术，如超高密度映射、等时晚期激活映射和波纹映射，提供了更好的心律失常基质描绘，提高了潜在的程序成功率，同时限制了消融程序的持续时间和潜在的血液动力学风险。此外，更先进的映射和消融技术，如心外膜和心肌内消融方法，使操作者能够更精确地靶向心律失常基质。此外，替代能源的进步，如电穿孔，以及立体定向放射治疗，已被证明是有效和安全的。新型导管，如格子和盐水增强射频导管，与传统导管相比，旨在提供更深、更持久的组织消融损伤。接触力优化和基线阻抗调制是优化 VT 射频消融和提高程序成功率的重要工具。此外，心脏成像技术的进步，特别是心脏 MRI，在识别心律失常基质和评估消融效果方面具有很大的潜力。总之，VA 消融在过去几年取得了重大进展。VA 映射技术、替代能源、新型导管以及心脏成像的应用具有很大的潜力，可以提高整体程序安全性、血液动力学稳定性和程序成功率。
