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3-D-Mapping und Ablation bei Postinfarktpatienten mit rezidivierenden Kammertachykardien

3-D mapping and ablation of recurrent ventricular tachycardia in patients with ischemic cardiomyopathy

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Zusammenfassung

Die Katheterablation ventrikulärer Tachykardien (VT) ist ein etabliertes Verfahren zur Reduktion von ICD-Therapien bei Postinfarktpatienten und hat in internationalen Leitlinien bei Patienten mit „incessant“ VT, elektrischem Sturm und rezidivierenden ICD-Schocks einen Klasse-I-Empfehlungsgrad. Zahlreiche Publikationen belegen den Nutzen der Ablation. Die Verwendung 3‑dimensionaler Mapping-Systeme ohne und mit Integration von Computertomographie- oder Magnetresonanztomographiebildern ist heute Standard bei der Ablation komplexer Rhythmusstörungen. Diese Systeme erleichtern das Verständnis für die Aktivierung bei VT. Auch wenn in vielen Fällen aufgrund der klinischen Präsentation eine Kombination aus Aktivierungs- und Substrat-Mapping erfolgt, scheint eine substratbasierte Ablation einer alleinigen Ablation der klinischen VT überlegen zu sein.

Abstract

Catheter ablation of ventricular tachycardia (VT) is an established therapy for patients with ischemic cardiomyopathy to reduce implantable cardioverter–defibrillator (ICD) interventions and is a class I recommendation in international guidelines. Numerous publications confirm its value. Use of three-dimensional mapping systems with or without image integration is standard for ablation of complex arrhythmias. In patients with history of myocardial infarction they help to understand activation of reentrant circuits and are prerequisite for substrate mapping. While a combination of activation and substrate mapping is performed in many patients based on clinical presentation, substrate-based ablation appears to be superior to clinical VT ablation alone.

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Literatur

  1. Arenal A, del Castillo S, Gonzalez-Torrecilla E, Atienza F, Ortiz M, Jimenez J, Puchol A, García J, Almendral J (2004) Tachycardia-related channel in the scar tissue in patients with sustained monomorphic ventricular tachycardias: influence of the voltage scar definition. Circulation 110:2568–2574

    Article  PubMed  Google Scholar 

  2. Baratto F, Pappalardo F, Oloriz T, Bisceglia C, Vergara P, Silberbauer J, Albanese N, Cireddu M, D’Angelo G, Di Prima AL, Monaco F, Paglino G, Radinovic A, Regazzoli D, Silvetti S, Trevisi N, Zangrillo A, Della BP (2016) Extracorporeal membrane oxygenation for hemodynamic support of ventricular tachycardia ablation. Circ Arrhythm Electrophysiol 9(12): pii:e004492. doi:10.1161/CIRCEP.116.004492

    Article  Google Scholar 

  3. Berruezo A, Fernández-Armenta J, Andreu D, Penela D, Herczku C, Evertz R, Cipolletta L, Acosta J, Borràs R, Arbelo E, Tolosana JM, Brugada J, Mont L (2015) Scar dechanneling: new method for scar-related left ventricular tachycardia substrate ablation. Circ Arrhythm Electrophysiol 8:326–336

    Article  PubMed  Google Scholar 

  4. Bogun F, Kim HM, Han J, Tamirissa K, Tschopp D, Reich S, Elmouchi D, Igic P, Lemola K, Good E, Oral H, Chugh A, Pelosi F, Morady F (2006) Comparison of mapping criteria for hemodynamically tolerated, postinfarction ventricular tachycardia. Heart Rhythm 3:20–26

    Article  PubMed  Google Scholar 

  5. Bunch TJ, Weiss JP, Crandall BG, Day JD, May HT, Bair TL, Osborn JS, Mallender C, Fischer A, Brunner KJ, Mahapatra S (2014) Patients treated with catheter ablation for ventricular tachycardia after an ICD shock have lower long-term rates of death and heart failure hospitalization than do patients treated with medical management only. Heart Rhythm 11:533–540

    Article  PubMed  Google Scholar 

  6. Callans DJ, Ren JF, Michele J, Marchlinski FE, Dillon SM (1999) Electroanatomic left ventricular mapping in the porcine model of healed anterior myocardial infarction. Correlation with intracardiac echocardiography and pathological analysis. Circulation 100:1744–1750

    Article  CAS  PubMed  Google Scholar 

  7. de Chillou C, Groben L, Magnin-Poull I, Andronache M, MagdiAbbas M, Zhang N, Abdelaal A, Ammar S, Sellal JM, Schwartz J, Brembilla-Perrot B, Aliot E, Marchlinski FE (2014) Localizing the critical isthmus of postinfarct ventricular tachycardia: the value of pace-mapping during sinus rhythm. Heart Rhythm 11:175–181

    Article  PubMed  Google Scholar 

  8. Di Biase L, Santangeli P, Burkhardt DJ, Bai R, Mohanty P, Carbucicchio C, Dello Russo A, Casella M, Mohanty S, Pump A, Hongo R, Beheiry S, Pelargonio G, Santarelli P, Zucchetti M, Horton R, Sanchez JE, Elayi CS, Lakkireddy D, Tondo C, Natale A (2012) Endo-epicardial homogenization of the scar versus limited substrate ablation for the treatment of electrical storms in patients with ischemic cardiomyopathy. J Am Coll Cardiol 60:132–141

    Article  PubMed  Google Scholar 

  9. Di Biase L, Burkhardt JD, Lakkireddy D, Carbucicchio C, Mohanty S, Mohanty P, Trivedi C, Santangeli P, Bai R, Forleo G, Horton R, Bailey S, Sanchez J, Al-Ahmad A, Hranitzky P, Gallinghouse GJ, Pelargonio G, Hongo RH, Beheiry S, Hao SC, Reddy M, Rossillo A, Themistoclakis S, Dello Russo A, Casella M, Tondo C, Natale A (2015) Ablation of stable VTs versus substrate ablation in ischemic cardiomyopathy: the VISTA randomized multicenter trial. J Am Coll Cardiol 66:2872–2882

    Article  PubMed  Google Scholar 

  10. Dinov B, Fiedler L, Schönbauer R, Bollmann A, Rolf S, Piorkowski C, Hindricks G, Arya A (2014) Outcomes in catheter ablation of ventricular tachycardia in dilated nonischemic cardiomyopathy compared with ischemic cardiomyopathy: results from the Prospective Heart Centre of Leipzig VT (HELP-VT) Study. Circulation 129:728–736

    Article  PubMed  Google Scholar 

  11. El-Shalakany A, Hadjis T, Papageorgiou P, Monahan K, Epstein L, Josephson ME (1999) Entrainment/mapping criteria for the prediction of termination of ventricular tachycardia by single radiofrequency lesion in patients with coronary artery disease. Circulation 99:2283–2289

    Article  CAS  PubMed  Google Scholar 

  12. Esposito A, Palmisano A, Antunes S, Maccabelli G, Colantoni C, Rancoita PM, Baratto F, Di Serio C, Rizzo G, De Cobelli F, Della Bella P, Del Maschio A (2016) Cardiac CT with delayed enhancement in the characterization of ventricular tachycardia structural substrate: relationship between CT-segmented scar and electro-anatomic mapping. JACC Cardiovasc Imaging 9:822–832

    Article  PubMed  Google Scholar 

  13. Jaïs P, Maury P, Khairy P, Sacher F, Nault I, Komatsu Y, Hocini M, Forclaz A, Jadidi AS, Weerasooryia R, Shah A, Derval N, Cochet H, Knecht S, Miyazaki S, Linton N, Rivard L, Wright M, Wilton SB, Scherr D, Pascale P, Roten L, Pederson M, Bordachar P, Laurent F, Kim SJ, Ritter P, Clementy J, Haïssaguerre M (2012) Elimination of local abnormal ventricular activities: a new end point for substrate modification in patients with scar-related ventricular tachycardia. Circulation 125:2184–2196

    Article  PubMed  Google Scholar 

  14. Kocovic DZ, Harada T, Friedman PL, Stevenson WG (1999) Characteristics of electrograms recorded at reentry circuit sites and bystanders during ventricular tachycardia after myocardial infarction. J Am Coll Cardiol 34:381–388

    Article  CAS  PubMed  Google Scholar 

  15. Kuck KH, Schaumann A, Eckardt L, Willems S, Ventura R, Delacrétaz E, Pitschner HF, Kautzner J, Schumacher B, Hansen PS, VTACH study group (2010) Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial. Lancet 375:31–40

    Article  PubMed  Google Scholar 

  16. Lü F, Eckman PM, Liao KK, Apostolidou I, John R, Chen T, Das GS, Francis GS, Lei H, Trohman RG, Benditt DG (2013) Catheter ablation of hemodynamically unstable ventricular tachycardia with mechanical circulatory support. Int J Cardiol 168:3859–3865

    Article  PubMed  Google Scholar 

  17. Mallidi J, Nadkarni GN, Berger RD, Calkins H, Nazarian S (2011) Meta-analysis of catheter ablation as an adjunct to medical therapy for treatment of ventricular tachycardia in patients with structural heart disease. Heart Rhythm 8:503–510

    Article  PubMed  Google Scholar 

  18. Marchlinski FE, Callans DJ, Gottlieb CD, Zado E (2000) Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy. Circulation 101:1288–1296

    Article  CAS  PubMed  Google Scholar 

  19. Maury P, Baratto F, Zeppenfeld K, Klein G, Delacretaz E, Sacher F, Pruvot E, Brigadeau F, Rollin A, Andronache M, Maccabelli G, Gawrysiak M, Brenner R, Forclaz A, Schlaepfer J, Lacroix D, Duparc A, Mondoly P, Bouisset F, Delay M, Hocini M, Derval N, Sadoul N, Magnin-Poull I, Klug D, Haïssaguerre M, Jaïs P, Della BP, De Chillou C (2014) Radio-frequency ablation as primary management of well-tolerated sustained monomorphic ventricular tachycardia in patients with structural heart disease and left ventricular ejection fraction over 30. Eur Heart J 35:1479–1485

    Article  PubMed  Google Scholar 

  20. Mizuno H, Vergara P, Maccabelli G, Trevisi N, Eng SC, Brombin C, Mazzone P, Della Bella P (2013) Contact force monitoring for cardiac mapping in patients with ventricular tachycardia. J Cardiovasc Electrophysiol 24:519–524

    Article  PubMed  Google Scholar 

  21. Mountantonakis SE, Park RE, Frankel DS, Hutchinson MD, Dixit S, Cooper J, Callans D, Marchlinski FE, Gerstenfeld EP (2013) Relationship between voltage map „channels“ and the location of critical isthmus sites in patients with post-infarction cardiomyopathy and ventricular tachycardia. J Am Coll Cardiol 61:2088–2095

    Article  PubMed  Google Scholar 

  22. Pokorney SD, Friedman DJ, Calkins H, Callans DJ, Daoud EG, Della-Bella P, Jackson KP, Shivkumar K, Saba S, Sapp J, Stevenson WG, Al-Khatib SM (2016) Catheter ablation of ventricular tachycardia: Lessons learned from past clinical trials and implications for future clinical trials. Heart Rhythm 13:1748–1754

    Article  PubMed  Google Scholar 

  23. Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ (2015) 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 36:2793–2867

    Article  PubMed  Google Scholar 

  24. Proietti R, Labos C, Davis M, Thanassoulis G, Santangeli P, Russo V, Di Biase L, Roux JF, Verma A, Natale A, Essebag V (2015) A systematic review and meta-analysis of the association between implantable cardioverter-defibrillator shocks and long-term mortality. Can J Cardiol 31:270–277

    Article  PubMed  Google Scholar 

  25. Reddy VY, Reynolds MR, Neuzil P, Richardson AW, Taborsky M, Jongnarangsin K, Kralovec S, Sediva L, Ruskin JN, Josephson ME (2007) Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med 357:2657–2665

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Santangeli P, Marchlinski FE (2016) Substrate mapping for unstable ventricular tachycardia. Heart Rhythm 13:569–583

    Article  PubMed  Google Scholar 

  27. Sapp JL, Wells GA, Parkash R, Stevenson WG, Blier L, Sarrazin JF, Thibault B, Rivard L, Gula L, Leong-Sit P, Essebag V, Nery PB, Tung SK, Raymond JM, Sterns LD, Veenhuyzen GD, Healey JS, Redfearn D, Roux JF, Tang AS (2016) Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs. N Engl J Med 375:111–121

    Article  CAS  PubMed  Google Scholar 

  28. Soejima K, Suzuki M, Maisel WH, Brunckhorst CB, Delacretaz E, Blier L, Tung S, Khan H, Stevenson WG (2001) Catheter ablation in patients with multiple and unstable ventricular tachycardias after myocardial infarction: short ablation lines guided by reentry circuit isthmuses and sinus rhythm mapping. Circulation 104:664–669

    Article  CAS  PubMed  Google Scholar 

  29. Soejima K, Stevenson WG, Maisel WH, Sapp JL, Epstein LM (2002) Electrically unexcitable scar mapping based on pacing threshold for identification of the reentry circuit isthmus: feasibility for guiding ventricular tachycardia ablation. Circulation 106:1678–1683

    Article  PubMed  Google Scholar 

  30. Stevenson WG, Wilber DJ, Natale A, Jackman WM, Marchlinski FE, Talbert T, Gonzalez MD, Worley SJ, Daoud EG, Hwang C, Schuger C, Bump TE, Jazayeri M, Tomassoni GF, Kopelman HA, Soejima K, Nakagawa H, Multicenter Thermocool VT Ablation Trial Investigators (2008) Irrigated radiofrequency catheter ablation guided by electroanatomic mapping for recurrent ventricular tachycardia after myocardial infarction: the multicenter thermocool ventricular tachycardia ablation trial. Circulation 118:2773–2782

    Article  PubMed  Google Scholar 

  31. Tung R, Mathuria NS, Nagel R, Mandapati R, Buch EF, Bradfield JS, Vaseghi M, Boyle NG, Shivkumar K (2013) Impact of local ablation on interconnected channels within ventricular scar: mechanistic implications for substrate modification. Circ Arrhythm Electrophysiol 6:1131–1138

    Article  PubMed  PubMed Central  Google Scholar 

  32. van Welsenes GH, van Rees JB, Borleffs CJ, Cannegieter SC, Bax JJ, van Erven L, Schalij MJ (2011) Long-term follow-up of primary and secondary prevention implantable cardioverter defibrillator patients. Europace 13:389–394

    Article  PubMed  Google Scholar 

  33. Yamashita S, Cochet H, Sacher F, Mahida S, Berte B, Hooks D, Sellal JM, Al Jefairi N, Frontera A, Komatsu Y, Lim HS, Amraoui S, Denis A, Derval N, Sermesant M, Laurent F, Hocini M, Haïssaguerre M, Montaudon M, Jaïs P (2016) Impact of new technologies and approaches for post-myocardial infarction ventricular tachycardia ablation during long-term follow-up. Circ Arrhythm Electrophysiol 9(7): pii:e003901. doi:10.1161/CIRCEP.116.003901

    Article  Google Scholar 

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Authors and Affiliations

  1. Abteilung für Rhythmologie, Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland

    Kristina Wasmer &  Lars Eckardt Prof. Dr. med.

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  1. Kristina Wasmer
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  2. Lars Eckardt Prof. Dr. med.
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Correspondence to Kristina Wasmer.

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K. Wasmer und L. Eckardt geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Wasmer, K., Eckardt, L. 3-D-Mapping und Ablation bei Postinfarktpatienten mit rezidivierenden Kammertachykardien. Herzschr Elektrophys 28, 199–205 (2017). https://doi.org/10.1007/s00399-017-0506-2

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