Alternative Approaches for Ablation of Resistant Ventricular Tachycardia.
Ventricular tachycardia (VT) ablation is usually performed with an ablation catheter that delivers unipolar radiofrequency (RF) energy to eliminate the re-entry circuit responsible for VT. However, there are some instances when unipolar RF ablation fails, notably in VTs with a deep intramural origin, or cases in which epicardial access is not attainable due to prior cardiac surgery. To overcome these limitations, several alternative approaches have been used in clinical practice, including alcohol ablation or coil embolization, simultaneous unipolar or bipolar RF ablation, surgical ablation, or noninvasive ablation with stereotactic radiosurgery. This review article describes some of these alternative techniques.
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Carola
C
Gianni
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA.
Sanghamitra
S
Mohanty
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.
Chintan
C
Trivedi
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
Luigi
L
Di Biase
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.
Amin
A
Al-Ahmad
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Division of Cardiology, Stanford University, Stanford, CA, USA; Atrial Fibrillation and Arrhythmia Center, California Pacific Medical Center, San Francisco, CA, USA.
Andrea
A
Natale
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA. Electronic address: jdavidburkhardt@gmail.com.
J
J
David Burkhardt
D055011:Ablation Techniques; D004621:Embolization, Therapeutic; D006801:Humans; D016634:Radiosurgery; D017180:Tachycardia, Ventricular / Q000601:surgery*
Alcohol ablation; Bipolar RF ablation; Coil embolization; Simultaneous unipolar RF ablation; Stereotactic ablative radiosurgery; Surgical ablation; Ventricular tachycardia