Substrate Ablation of Ventricular Tachycardia: Late Potentials, Scar Dechanneling, Local Abnormal Ventricular Activities, Core Isolation, and Homogenization.
Ventricular arrhythmias are a frequent cause of mortality in patients with ischemic cardiomyopathy and nonischemic cardiomyopathy. Scar-related reentry represents the most common arrhythmia substrate in patients with recurrent episodes of sustained ventricular tachycardia (VT). Initial mapping of scar-related VT circuits is focused on identifying arrhythmogenic tissue. The substrate-based strategies include targeting late potentials, scar dechanneling, local abnormal ventricular activities, core isolation, and homogenization of the scar. Even though substrate-based strategies for VT ablation have shown promising outcomes for patients with structural heart disease related to ischemic cardiomyopathy, the data are scarce for patients with nonischemic substrates.
Division of Cardiovascular Disease, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
David F
DF
Briceño
Division of Cardiovascular Disease, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
Jorge
J
Romero
Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Austin, TX 78705, USA.
Carola
C
Gianni
Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Austin, TX 78705, USA.
Sanghamitra
S
Mohanty
Division of Cardiovascular Disease, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
Pedro A
PA
Villablanca
Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Austin, TX 78705, USA; Department of Biomedical Engineering, University of Texas, 107 W Dean Keeton Street, Austin, TX 78712, USA.
Andrea
A
Natale
Division of Cardiovascular Disease, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA; Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Austin, TX 78705, USA; Department of Biomedical Engineering, University of Texas, 107 W Dean Keeton Street, Austin, TX 78712, USA; Department of Cardiology, University of Foggia, Via Antonio Gramsci, 71122 Foggia FG, Italy. Electronic address: dibbia@gmail.com.
Luigi
L
Di Biase
D055011:Ablation Techniques / Q000009:adverse effects / Q000379:methods; D006801:Humans; D017180:Tachycardia, Ventricular / Q000601:surgery*
Structural heart disease; Substrate ablation; Ventricular arrhythmia; Ventricular tachycardia