Different road maps for ventricular tachycardia ablation

摘要

Catheter ablation is being used increasingly to treat patients with ischaemic scars who are suffering from recurrent haemodynamically tolerated and untolerated ventricular tachycardia (VT). Its main goal is to locate and ablate isthmuses critical for sustaining the VT. Functionally, this is achieved by using pacing manoeuvres and entrainment mapping to identify which areas represent critical parts of the reentrant circuit [1]. Alternatively, the substrate of the VT is assessed on a structural level by identifying low-voltage or fractionated local electrograms, without demonstrating that these abnormalities contribute to the arrhythmia. A randomised trial comparing substrate-based VT ablation with functional VT ablation using pacing manoeuvres and entrainment showed that substrate modification causes lower rates of VT recurrence and hospitalisation than functional VT ablation as well as a trend toward lower mortality [2].