Optimal ablation strategies for different types of ventricular tachycardias.
Ablation strategies for almost all types of ventricular tachycardias have now been                 established. The optimal ablation strategy for ventricular tachycardia is determined                 by the site of origin and the electrophysiological mechanisms. Electrocardiograms,                 an understanding of the common sites of basic disease, and identification of the                 scar site using imaging modalities might be helpful for predicting the originating                 location. Electrophysiological activation mapping is the gold standard for                 identification of the ventricular tachycardia substrate. However, when activation                 mapping of scar-related ventricular tachycardias is not possible, substrate mapping                 might be performed to identify isolated diastolic potentials. Substrates are                 commonly located in the endocardium, but transvenous or subxiphoidal                 intrapericardial approaches can be used to map epicardial substrates. Unusual types                 of ventricular tachycardia might require special strategies, such as transcoronary                 ethanol or intramural needle ablation. For idiopathic ventricular tachycardias,                 ablation might be a first-line therapy because of its high efficacy and very low                 risk of complications. However, the recurrence rate of scar-related ventricular                 tachycardias remains considerable, and ablation remains an adjunctive therapy to                 medical therapy and implantable cardioverter-defibrillators. When incessant                 ventricular tachycardia or fibrillation requiring defibrillator therapy (electrical                 storm) is refractory to antiarrhythmic drugs, neuraxial modulation, including                 sedation, might be the next option before catheter ablation is attempted.
Division of Cardiovascular Disease, University of Alabama at Birmingham, FOT 930, 1530 3rd Avenue South, Birmingham, AL 35294-0019, USA. takumi-y@ fb4.so-net.ne.jp
Takumi
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Yamada
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D018780:Body Surface Potential Mapping / Q000379:methods*; D002037:Bundle-Branch Block; D017115:Catheter Ablation / Q000379:methods*; D017147:Defibrillators, Implantable; D004562:Electrocardiography / Q000379:methods; D006801:Humans; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000473:pathology / Q000601:surgery*