Skip to main content
SpringerLink
Log in

Ablation ventrikulärer Tachykardien bei Herzinsuffizienz

Ablation of ventricular tachycardia for cardiac insufficiency

  • Interventionelle Elektrophysiologie
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Ventrikuläre Tachykardien (VT), Schocks und VT-Cluster sind bei Patienten mit implantierbaren Defibrillatoren (ICD) mit einem erhöhten Risiko für Sterblichkeit und Krankenhausaufenthalte assoziiert. VT-Cluster werden häufig bei einer Verschlechterung der Herzinsuffizienz, im Rahmen von akuten Koronarereignissen und bei Elektrolytimbalancen gesehen. Die Assoziation ist oft nur vage und nur selten kausal. Möglicherweise muss bei Patienten, die ein Substrat für ventrikuläre Reentrytachykardien haben, immer von einer zunehmenden Häufung der VTs ausgegangen werden. Die hohe Rezidivrate von VT-Stürmen nach medikamentöser Einstellung spricht für diese Sichtweise. Die VT-Ablation scheint der medikamentösen Therapie überlegen zu sein. Der optimale Zeitpunkt für eine Ablation ist nicht bekannt. Eine prophylaktische Ablation wird nur von wenigen Zentren vorgenommen. Selbst eine frühzeitige Ablation, z. B. nach dem ersten Schock, wird nur in wenigen Zentren durchgeführt. Obgleich diese Vorgehensweise durchaus leitlinienkonform ist, spricht heute vieles für eine prophylaktische VT-Ablation bereits nach dem ersten Schock, bzw. der ersten VT.

Abstract

Ventricular tachycardia (VT), shock and shock clusters are ominous signs in patients with implantable cardioverter defibrillators (ICDs) and herald an increased risk of hospitalization and mortality. The occurrence of VT clusters has been associated with aggravation of heart failure in 19%, to acute coronary events in 14% and electrolyte imbalance in 10%. However, any association of potential causative factors and aggravation of VT is vague. In patients with a substrate for ventricular re-entry tachycardia, progressive aggravation of ventricular dysrhythmia should possibly be expected. The high recurrence rate of shock clusters despite antiarrhythmic drug therapy supports this view. The optimal timing of VT ablation is unknown but current convention is to perform VT ablation after shock clusters or incessant VT has occurred. Preemptive VT ablation is rarely performed (only in 15% of active centers) and the majority of centers never perform VT ablation even after the first shock. Such practice is within guidelines that recommend VT ablation only in ICD patients with recurrent or incessant VT. However, there is strong data in support of preemptive VT ablation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Aliot EM, Stevenson WG, Almendral-Garrote JM et al (2009) EHRA/HRS expert consensus on catheter ablation of ventricular arrhythmias. Europace 11:771–817

    Article  PubMed  Google Scholar 

  2. Hohnloser SH, Al Khalidi HR, Pratt CM et al (2006) Electrical storm in patients with an implantable defibrillator: incidence, features, and preventive therapy: insights from a randomized trial. Eur Heart J 27:3027–3032

    Article  PubMed  Google Scholar 

  3. Brigadeau F, Kouakam C, Klug D et al (2006) Clinical predictors and prognostic significance of electrical storm in patients with implantable cardioverter defibrillators. Eur Heart J 27:700–707

    Article  PubMed  Google Scholar 

  4. Exner DV, Pinski SL, Wyse DG et al (2001) Electrical storm presages nonsudden death – the antiarrhythmics versus implantable defibrillators (AVID) trial. Circulation 103:2066–2071

    PubMed  CAS  Google Scholar 

  5. Wilber DJ, Zareba W, Hall WJ et al (2004) Time dependence of mortality risk and defibrillator benefit after myocardial infarction. Circulation 109:1082–1084

    Article  PubMed  Google Scholar 

  6. Sesselberg HW, Moss AJ, McNitt S et al (2007) Ventricular arrhythmia storms in postinfarction patients with implantable defibrillators for primary prevention indications: a MADIT-II substudy. Heart Rhythm 4:1395–1402

    Article  PubMed  Google Scholar 

  7. Bansch D, Castrucci M, Bocker D et al (2000) Ventricular tachycardias above the initially programmed tachycardia detection interval in patients with implantable cardioverter-defibrillators – incidence, prediction and significance. J Am Coll Cardiol 36:557–565

    Article  PubMed  CAS  Google Scholar 

  8. Connolly SJ, Dorian P, Roberts RS et al (2006) Comparison of beta-blockers, amiodarone plus beta-blockers, or sotalol for prevention of shocks from implantable cardioverter defibrillators – the optic study. A randomized trial. JAMA 295:165–171

    Article  PubMed  CAS  Google Scholar 

  9. Pogwizd SM, McKenzie JP, Cain ME (1998) Mechanisms underlying spontaneous and induced ventricular arrhythmias in patients with idiopathic dilated cardiomyopathy. Circulation 98:2404–2414

    PubMed  CAS  Google Scholar 

  10. Hsia HH, Callans DJ, Marchlinski FE (2003) Characterization of endocardial electrophysiological substrate in patients with nonischemic cardiomyopathy and monomorphic ventricular tachycardia. Circulation 108:704–710

    Article  PubMed  Google Scholar 

  11. Tedrow U, Stevenson WG (2009) Strategies for epicardial mapping and ablation of ventricular tachycardia. J Cardiovasc Electrophysiol 20:710–713

    Article  PubMed  Google Scholar 

  12. Sosa E, Scanavacca M, D’Avila A et al (1996) A new technique to perform epicardial mapping in the electrophysiology laboratory. J Cardiovasc Electrophysiol 7:531–536

    Article  PubMed  CAS  Google Scholar 

  13. Soejima K, Delacretaz E, Suzuki M et al (2001) Saline-cooled versus standard radiofrequency catheter ablation for infarct-related ventricular tachycardias. Circulation 103:1858–1862

    PubMed  CAS  Google Scholar 

  14. Stevenson WG, Friedman PL, Ganz LI (1997) Radiofrequency catheter ablation of ventricular tachycardia late after myocardial infarction. J Cardiovasc Electrophysiol 8:1309–1319

    Article  PubMed  CAS  Google Scholar 

  15. Stevenson WG, Sager P, Nademanee K et al (1992) Identifying sites for catheter ablation of ventricular tachycardia. Herz 17:158–170

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  17. Chillou C de, Lacroix D, Klug D et al (2002) Isthmus characteristics of reentrant ventricular tachycardia after myocardial infarction. Circulation 105:726–731

    Article  PubMed  Google Scholar 

  18. Carbucicchio C, Santamaria M, Trevisi N et al (2008) Catheter ablation for the treatment of electrical storm in patients with Implantable cardioverter-defibrillators – short- and long-term outcomes in a prospective single-center study. Circulation 117:462–469

    Article  PubMed  Google Scholar 

  19. Della Bella S, Taddeo A, Colombo E et al (2010) Human herpesvirus-8 infection leads to expansion of the preimmune/natural effector B cell compartment. Plos One:5

    Google Scholar 

  20. Reddy VY, Neuzil P, Taborsky M et al (2003) Short-term results of substrate mapping and radiofrequency ablation of ischemic ventricular tachycardia using a saline-irrigated catheter. J Am Coll Cardiol 41:2228–2236

    Article  PubMed  Google Scholar 

  21. Dagres D, Cantu F, Geelen P et al (2012) Current practice of ventricular tachycardia ablation in patients with implantable cardioverter-defibrillators. Europace 14:135–137

    Article  PubMed  Google Scholar 

  22. Marchlinski FE, Callans DJ, Russo A et al (2000) Normal ventricular electrogram signal amplitude using magnetic electroanatomic mapping: influence of recording polarity and mapped chamber. J Am Coll Cardiol 35:120A

    Google Scholar 

  23. Bogun F, Good E, Reich S et al (2006) Isolated potentials during sinus rhythm and pace-mapping within scars as guides for ablation of post-infarction ventricular tachycardia. J Am Coll Cardiol 47:2013–2019

    Article  PubMed  Google Scholar 

  24. Bogun F, Kim HM, Han J et al (2006) Comparison of mapping criteria for hemodynamically tolerated, postinfarction ventricular tachycardia. Heart Rhythm 3:20–26

    Article  PubMed  Google Scholar 

  25. Arenal A, Castillo S del, Gonzalez-Torrecilla E et al (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 

  26. Hsia HH, Lin D, Sauer WH et al (2006) Anatomic characterization of endocardial substrate for hemodynamically stable reentrant ventricular tachycardia: Identification of endocardial conducting channels. Heart Rhythm 3:503–512

    Article  PubMed  Google Scholar 

  27. Soejima K, Stevenson WG, Maisel WH et al (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 

  28. Nakahara S, Tung R, Ramirez RJ et al (2010) Distribution of late potentials within infarct scars assessed by ultra high-density mapping. Heart Rhythm 7:1817–1824

    Article  PubMed  Google Scholar 

  29. Carbucicchio C, Della Bella P, Fassini G et al (2009) Percutaneous cardiopulmonary support for catheter ablation of unstable ventricular arrhythmias in high-risk patients. Herz 34:545–552

    Article  PubMed  Google Scholar 

  30. Bunch TJ, Weiss JP, Crandall BG et al (2010) Image integration using intracardiac ultrasound and 3D reconstruction for scar mapping and ablation of ventricular tachycardia. J Cardiovasc Electrophysiol 21:678–684

    Article  PubMed  Google Scholar 

  31. Carbucicchio C, Santamaria M, Trevisi N et al (2008) Catheter ablation for the treatment of electrical storm in patients with implantable cardioverter-defibrillators – short- and long-term outcomes in a prospective single-center study. Circulation 117:462–469

    Article  PubMed  Google Scholar 

  32. Della Bella P, Pappalardo A, Riva S et al (2002) Non-contact mapping to guide catheter ablation of untolerated ventricular tachycardia. Eur Heart J 23:742–752

    Article  Google Scholar 

  33. Stevenson WG, Friedman PL, Kocovic D et al (1998) Radiofrequency catheter ablation of ventricular tachycardia after myocardial infarction. Circulation 98:308–314

    PubMed  CAS  Google Scholar 

  34. Stevenson WG, Sager P, Nademanee K et al (1992) Identifying sites for catheter ablation of ventricular-tachycardia. Herz 17:158–170

    PubMed  CAS  Google Scholar 

  35. Frankel DS, Mountantonakis SE, Robinson MR et al (2011) Ventricular tachycardia ablation remains treatment of last resort in structural heart disease: argument for earlier intervention. J Cardiovasc Electrophysiol 22:1123–1128

    Article  PubMed  Google Scholar 

  36. Tchou P, Jazayeri M, Denker S et al (1988) Transcatheter electrical ablation of right bundle-branch – a method of treating macroreentrant ventricular-tachycardia attributed to bundle-branch reentry. Circulation 78:246–257

    Article  PubMed  CAS  Google Scholar 

  37. Caceres J, Jazayeri M, Mckinnie J et al (1989) Sustained bundle-branch reentry as a mechanism of clinical tachycardia. Circulation 79:256–270

    Article  PubMed  CAS  Google Scholar 

  38. Delacretaz E, Stevenson WG, Ellison KE et al (2000) Mapping and radiofrequency catheter ablation of the three types of sustained monomorphic ventricular tachycardia in nonischemic heart disease. J Cardiovasc Electrophysiol 11:11–17

    Article  PubMed  CAS  Google Scholar 

  39. Bansch D, Oyang F, Antz M et al (2003) Successful catheter ablation of electrical storm after myocardial infarction. Circulation 108:3011–3016

    Article  PubMed  Google Scholar 

  40. Bogun F, Good E, Reich S et al (2006) Role of Purkinje fibers in post-infarction ventricular tachycardia. J Am Coll Cardiol 48:2500–2507

    Article  PubMed  Google Scholar 

  41. Mallidi J, Nadkarni GN, Berger RD et al (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 

  42. Calkins H, Epstein A, Packer D et al (2000) Catheter ablation of ventricular tachycardia in patients with structural heart disease using cooled radiofrequency energy: results of a prospective multicenter study. Cooled RF Multi Center Investigators Group. J Am Coll Cardiol 35:1905–1914

    Article  PubMed  CAS  Google Scholar 

  43. Reddy VY, Richardson AW, Neuzil P et al (2004) Initial results from the substrate mapping and ablation in sinus rhythm to halt ventricular tachycardia trial (SMASH VT). J Am Coll Cardiol 43:153A–154A

    Article  Google Scholar 

  44. Stevenson WG, Wilber DJ, Natale A et al (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 

  45. Aliot EM, Stevenson WG, Almendral-Garrote JM et al (2009) EHRA/HRS expert consensus on catheter ablation of ventricular arrhythmias. Europace 11:771–817

    Article  PubMed  Google Scholar 

  46. Kottkamp H, Hindricks G, Chen X et al (1995) Radiofrequency catheter ablation of sustained ventricular-tachycardia in idiopathic dilated cardiomyopathy. Circulation 92:1159–1168

    PubMed  CAS  Google Scholar 

  47. Yokokawa M, Good E, Crawford T et al (2011) Ventricular tachycardia originating from the aortic sinus cusp in patients with idiopathic dilated cardiomyopathy. Heart Rhythm 8:357–360

    Article  PubMed  Google Scholar 

  48. Soejima K, Couper G, Cooper JM et al (2004) Subxiphoid surgical approach for epicardial catheter-based mapping and ablation in patients with prior cardiac surgery or difficult pericardial access. Circulation 110:1197–1201

    Article  PubMed  Google Scholar 

  49. Soejima K, Stevenson WG, Sapp JL et al (2004) Endocardial and epicardial radiofrequency ablation of ventricular tachycardia associated with dilated cardiomyopathy: the importance of low-voltage scars. J Am Coll Cardiol 43:1834–1842

    Article  PubMed  Google Scholar 

  50. Inada K, Roberts-Thomson KC, Seiler J et al (2010) Mortality and safety of catheter ablation for antiarrhythmic drug-refractory ventricular tachycardia in elderly patients with coronary artery disease. Heart Rhythm 7:740–744

    Article  PubMed  Google Scholar 

  51. Kuck KH, Schaumann A, Eckardt L et al (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 

  52. Niwano S, Fukaya H, Yuge M et al (2008) Role of electrophysiologic study (EPS)-guided preventive therapy for the management of ventricular tachyarrhythmias in patients with heart failure. Circ J 72:268–273

    Article  PubMed  Google Scholar 

  53. Stevenson WG, Sager P, Nademanee K et al (1992) Identifying sites for catheter ablation of ventricular-tachycardia. Herz 17:158–170

    PubMed  CAS  Google Scholar 

  54. Kolandaivelu A, Lardo AC, Halperin HR (2009) Cardiovascular magnetic resonance guided electrophysiology studies. J Cardiovasc Magn Reson 11:21

    Article  PubMed  Google Scholar 

  55. Kolandaivelu A, Zviman MM, Castro V et al (2010) Noninvasive assessment of tissue heating during cardiac radiofrequency ablation using MRI thermography. Circulation 3:U521–U534

    Google Scholar 

  56. Nazarian S, Kolandaivelu A, Zviman MM et al (2008) Feasibility of real-time magnetic resonance imaging for catheter guidance in electrophysiology studies. Circulation 118:223–229

    Article  PubMed  Google Scholar 

  57. Bogun FM, Desjardins B, Good E et al (2009) Delayed-enhanced magnetic resonance imaging in nonischemic cardiomyopathy utility for identifying the ventricular arrhythmia substrate. J Am Coll Cardiol 53:1138–1145

    Article  PubMed  Google Scholar 

  58. Sosa E, Scanavacca M, D’Avila A et al (1998) Endocardial and epicardial ablation guided by nonsurgical transthoracic epicardial mapping to treat recurrent ventricular tachycardia. J Cardiovasc Electrophysiol 9:229–239

    Article  PubMed  CAS  Google Scholar 

  59. Sosa E, Scanavacca M, D’Avila A et al (2000) Nonsurgical transthoracic epicardial catheter ablation to treat recurrent ventricular tachycardia occurring late after myocardial infarction. J Am Coll Cardiol 35:1442–1449

    Article  PubMed  CAS  Google Scholar 

  60. Schmidt B, Chun KRJ, Baensch D et al (2010) Catheter ablation for ventricular tachycardia after failed endocardial ablation: epicardial substrate or inappropriate endocardial ablation? Heart Rhythm 7:1746–1752

    Article  PubMed  Google Scholar 

  61. Hohnloser SH, Dorian P, Roberts R et al (2006) Effect of amiodarone and sotalol on ventricular defibrillation threshold – The Optimal Pharmacological Therapy in Cardioverter Defibrillator Patients (OPTIC) trial. Circulation 114:104–109

    Article  PubMed  CAS  Google Scholar 

  62. Connolly SJ, Hallstrom AP, Cappato R et al (2000) Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials. Eur Heart J 21:2071–2078

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Keine Angabe.

Author information

Authors and Affiliations

  1. Herzzentrum, Universität Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland

    D. Bänsch MD, R. Schneider, I. Akin & C.A. Nienaber

Authors
  1. D. Bänsch MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I. Akin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C.A. Nienaber
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Bänsch MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bänsch, D., Schneider, R., Akin, I. et al. Ablation ventrikulärer Tachykardien bei Herzinsuffizienz. Kardiologe 6, 135–147 (2012). https://doi.org/10.1007/s12181-012-0407-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12181-012-0407-x

Schlüsselwörter

Keywords

Search

Navigation