Empfehlung der Deutschen Gesellschaft für Kardiologie zur Katheterablation ventrikulärer Arrhythmien

Recommendations of the German Cardiac Society on catheter ablation of ventricular arrhythmia

Zusammenfassung

Die Katheterablation ventrikulärer Tachykardien (VT) stellt für viele Patienten mit und ohne strukturelle Herzerkrankung eine effektive Therapieoption dar. Bei Patienten ohne strukturelle Herzerkrankung (idiopathische VT oder ventrikuläre Extrasystolen [VES]) erfolgt die Indikationsstellung üblicherweise symptombezogen. Die Ablation asymptomatischer VES erscheint nur zur Wiederherstellung einer eingeschränkten Ventrikelfunktion gerechtfertigt. Bisher konnte keine Studie einen Mortalitätsvorteil durch die VT-Ablation demonstrieren, allerdings zeigt sich je nach zugrunde liegender kardialer Pathologie in unterschiedlichem Ausmaß eine Reduktion von VT-Rezidiven. Die Indikation zur Ablation von VT bei ischämischer Kardiomyopathie basiert auf mehreren randomisierten Studien, wohingegen die Indikationsempfehlungen zur Ablation bei nichtischämischer VT auf Daten aus Expertenzentren basieren. Eine Klasse-I-Empfehlung zur Katheterablation gibt es unabhängig von der kardialen Pathologie für Patienten mit rezidivierenden VTs trotz chronischer antiarrhythmischer Therapie sowie im elektrischen Sturm. Bei Patienten mit nichtischämischer Kardiomyopathie ist häufig ein epikardiales Vorgehen notwendig. In diesen Fällen können das VT-EKG und die präinterventionelle Bildgebung hilfreich sein. Das intraprozedurale Vorgehen zur Ablation von VTs bei struktureller Herzerkrankung kann auf einer Identifikation von VT-Kanälen mittels präinterventioneller Bildgebung sowie intraprozeduralem Mapping mit einem elektroanatomischen Mappingsystem basieren, zunehmend wird ein High-Density-Mapping angewendet. Entscheidend erscheint die notwendig hohe Expertise der Untersucher und des durchführenden Teams zur Versorgung von Patienten mit VTs. Das Einbinden eines multidisziplinären Teams in der Betreuung von VT-Patienten erscheint insbesondere auch zur optimierten Therapie der Grunderkrankung sinnvoll. Für die Versorgungsstruktur in Deutschland ist die Einbindung einer rhythmologischen Expertise für die differenzierte Versorgung von Patienten mit VTs notwendig. Die epikardiale Ablation von VTs sollte sinnvollerweise in Zentren mit einer dokumentierten Erfahrung von mindestens 75 Ablationen ventrikulärer Arrhythmien sowie allen Voraussetzungen für ein effektives und sicheres Management dieser komplex kranken Patienten erfolgen.

Abstract

Catheter ablation of ventricular tachycardia (VT) has been documented to be an effective treatment option in patients with and without structural heart disease. In patients without structural heart disease the indications for ablation are based on symptomatic VT or prematur ventricular complexes (PVC). Ablation of asymptomatic PVC is reserved for reversal of left ventricular dysfunction. No study so far has indicated a benefit of VT ablation with respect to mortality in patients with structural heart disease. The use of VT ablation leads to a reduction of VT recurrences depending on the underlying structural cardiac pathology. Indications for VT ablation in ischemic cardiomyopathy are based on the results of multiple randomized trials, whereas in nonischemic cardiomyopathy VT patients recommendations are based on data from expert ablation centers. Ablation is recommended in patients with recurrent VT despite chronic antiarrhythmic medication. In patients with nonischemic VT epicardial ablation is frequently needed and VT electrocardiograph (ECG) and preinterventional cardiac imaging may be helpful for procedural planning. As VT ablation is a complex procedure, the experience of the surgeon, team and center appear to be decisive. A multidisciplinary team approach to patients with structural VT to optimize treatment of the underlying cardiac pathology may be of help. For Germany recommendations on how to organize VT treatment, requirements for operator and center experience and prerequisites for epicardial VT ablation are documented.

This is a preview of subscription content, access via your institution.

Abbreviations

AAD:

Antiarrhythmika („anti-arrhythmic drug“)

ATP:

Anti-Tachykardie-Pacing

BBR:

Bundle Branch Reentry

CALYPSO:

Catheter Ablation for VT in Patients with an Implantable Cardioverter Defibrillator (Studie)

CT:

Computertomographie/-tomogramm

DEEP:

Decrement evoked potential

ICM:

Ischämische Kardiomyopathie

ICD:

Implantierbarer Kardioverter/Defibrillator

LAA:

Linkes Vorhofohr („left atrial appendage“)

LAVA:

Late abnormal ventricular activation

LV:

Linker Ventrikel

MRT:

Magnetresonanztomographie/-tomogramm

NICM:

Nichtischämische Kardiomyopathie

NIPS:

Nichtinvasive programmierte Stimulation

OT:

Ausflusstrakt („outflow tract“)

PAAINESD:

Risiko Score (= Pulmonary Disease [Lungenerkrankung], Age (Alter), General Anaesthesia [Vollnarkose], Ischemic cardiomyopathy [koronare Herzerkrankung], NYHA, Ejection fraction [Ejektionsfraktion], VT-Storm [VT-Sturm], Diabetes [Diabetes mellitus])

RF:

Radiofrequenz

RV:

Rechter Ventrikel

SMASH-VT:

Substrate Mapping and Ablation in Sinus Rhythm to Halt Ventricular Tachycardia (Studie)

SMS:

Substrate Modification Study (Studie)

SR:

Sinusrhythmus

TEE:

Transösophageale Echokardiographie

VA:

Ventrikuläre Arrhythmien

VANISH:

Ventricular Tachycardia Ablation versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease (Studie)

VES:

Ventrikuläre Extrasystole(n)

VT:

Ventrikuläre Tachykardie(n)

VTACH:

Ventricular Tachycardia Ablation in Coronary Heart Disease (Studie)

Literatur

  1. 1.

    Eckardt L et al (2018) Updated survey on interventional electrophysiology. 5‑year follow-up of infrastructure, procedures and training positions in Germany. J Am Coll Cardiol 4:820–827

    Google Scholar 

  2. 2.

    Cronin et al (2019) 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace. https://doi.org/10.1093/europace/euz132

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Priori SG et al (2015) 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Europace 17:1601–1687

    Google Scholar 

  4. 4.

    Al-Khatib et al (2018) 2017 AHA/ACC/HRS guideline for the management of patients with ventricular arrythmias and the prevention of sudden cardiac death. Heart Rhythm 15:e73–e189

    PubMed  Article  PubMed Central  Google Scholar 

  5. 5.

    Busch S et al (2019) Ventrikuläre Extrasystolen und Tachykardien bei strukturell normalem Herz. Herzschrittmacher Elektrophysiol 30:212–224

    Article  Google Scholar 

  6. 6.

    Steven D et al (2013) Idiopathic ventricular outflow tract arrhythmias from the great cardiac vein: challenges and risks of catheter ablation. Int J Cardiol 169:366–370

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  7. 7.

    Stevenson W 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

    PubMed  Article  PubMed Central  Google Scholar 

  8. 8.

    Carbucicchio C 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

    PubMed  Article  PubMed Central  Google Scholar 

  9. 9.

    Tung R et al (2015) Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: an International VT Ablation Center Collaborative Group study. Heart Rhythm 9:1997–2007

    Article  Google Scholar 

  10. 10.

    Dinov B et al (2014) Outcomes in catheter ablation of ventricular tachycardia in dilated nonischemic cardiomyopathy compared with Ischemic cardiomyopathy: results form the prospective heart centre of leipzig VT (HELLP-VT) study. Circulation 129:728–736

    PubMed  Article  PubMed Central  Google Scholar 

  11. 11.

    Kuck KH et al (2010) Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randmoised controlled trial. Lancet 375:31–40

    PubMed  Article  PubMed Central  Google Scholar 

  12. 12.

    Reddy VA et al (2007) Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med 357:2657–2665

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  13. 13.

    Sapp JL et al (2016) Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs. N Engl J Med 375:111–121

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  14. 14.

    Al-Khatib SM et al (2015) Catheter ablation for ventricular tachycardia in patients with an implantable cardioverter defibrillator (CALYPSO) pilot trial. J Cardiovasc Electrophysiol 26:151–157

    PubMed  Article  PubMed Central  Google Scholar 

  15. 15.

    Kuck HK et al (2017) Impact of substrate modification by catheter ablation on implantable cardioverter-defibrillator interventions in patients with unstable ventricular arrhythmias and coronary artery disease: results from the multicenter randomized controlled SMS (Substrate Modification Study). Circ Arrhythm Electrophysiol. https://doi.org/10.1161/CIRCEP.116.004422

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Martinez BK et al (2019) Systematic review and meta-analysis of catheter ablation of ventricular tachycardia in ischemic heart disease. Heart Rhythm 1:e206–e219

    Google Scholar 

  17. 17.

    Anderson RD et al (2019) Catheter ablation versus medical therapy for treatment of ventricular tachycardia associated with structural heart disease: systematic review and meta-analysis of randomized controlled trials and comparison with observational studies. Heart Ryhthm 16:1484–1491

    Article  Google Scholar 

  18. 18.

    Willems S et al (2020) Preventive or deferred ablation of ventricular tachycardia in patients with Ischemic Cardiomyopathy and Implantable Defibrillator (BERLIN VT). Circulation 141:1057–1067

    PubMed  Article  PubMed Central  Google Scholar 

  19. 19.

    Wolf M et al (2018) Long-term outcome of substrate modification in ablation of post-myocardial infarction ventricular tachycardia. Circ Arrhythm Electrophysiol. https://doi.org/10.1161/CIRCEP/.117.005635

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Porta-Sánchez A et al (2018) Multicenter study of Ischemic ventricular tachycardia ablation with decrement-evoked potential (DEEP) mapping with extra stimulus. J Am Coll Cardiol 4:307–315

    Google Scholar 

  21. 21.

    de Riva M et al (2018) Targeting the hidden substrate unmasked by right ventricular extrastimulation improves ventricular tachycardia ablation outcomes after myocardial infarction. J Am Coll Cardiol 4:316–327

    Google Scholar 

  22. 22.

    Vaseghi M et al (2018) Outcomes of catheter ablation of ventricular tachycardia based on etiology in nonischemic heart disease: an international ventricular tachycardia ablation center collaborative study. J Am Coll Cardiol 4:1141–1150

    Google Scholar 

  23. 23.

    Muser D et al (2016) Long-term outcome after catheter ablation of ventricular tachycardia in patients with nonischemic dilated cardiomyopathy. Circ Arrhythm Electrophysiol. https://doi.org/10.1161/CIRCEP/116.004328

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Gökoglan Y et al (2016) Scar homogenization versus limited-substrate ablation in patients with nonischemic cardiomyopathy and ventricular tachycardia. J Am Coll Cardiol 68:1990–1998

    PubMed  Article  PubMed Central  Google Scholar 

  25. 25.

    Wasmer K et al (2013) Ventricular arrhythmias from the mitral annulus: patient characteristics, electrophysiological findings, ablation and prognosis. Heart Rhythm 10:783–788

    PubMed  Article  PubMed Central  Google Scholar 

  26. 26.

    Zeppenfeld K et al (2007) Catheter ablation of ventricular tachycardia after repair of congentital heart disease: electroanatomic identification of the critical right ventricular isthmus. Circulation 116:2241–2252

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  27. 27.

    Santangeli P et al (2017) Management of ventricular arrhythmia in patients with advanced heart failure. J Am Coll Cardiol 69:1842–1860

    PubMed  Article  PubMed Central  Google Scholar 

  28. 28.

    Muser D et al (2018) Identifying risk and management of acute haemodynamic decompensation during catheter ablation of ventricular tachycardia. Arrhythm Electrophysiol Rev 7:282–287

    PubMed  PubMed Central  Article  Google Scholar 

  29. 29.

    Vergara P (2018) Predictive score for identifying survival and recurrence risk profiles in patients undergoing ventricular tachycardia ablation. The I–VT score. Circ Arrhythm Electrophysiol. https://doi.org/10.1161/CIRCEP.118.00673

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Silberbauer J, Oloriz T, Maccabelli G et al (2014) Noninducibility and late potential abolition: a novel combined prognostic procedural end point for catheter ablation of postinfarction ventricular tachycardia. Circ Arrhythm Electrophysiol 7:424–435

    PubMed  Article  PubMed Central  Google Scholar 

  31. 31.

    Frankel DS, Mountantonakis SE, Zado ES et al (2012) Noninvasive programmed ventricular stimulation early after ventricular tachycardia ablation to predict risk of late recurrence. J Am Coll Cardiol 59:1529–1535

    PubMed  Article  PubMed Central  Google Scholar 

  32. 32.

    Bogun F, Taj M, Ting M et al (2008) Spatial resolution of pace mapping of idiopathic ventricular tachycardia/ectopy originating in the right ventricular outflow tract. Heart Rhythm 5:339–344

    PubMed  Article  PubMed Central  Google Scholar 

  33. 33.

    Tung R, Nakahara S, Ramirez R, Lai C, Fishbein MC, Shivkumar K (2010) Distinguishing epicardial fat from scar: analysis of electrograms using high-density electroanatomic mapping in a novel porcine infarct model. Heart Rhythm 7:389–395

    PubMed  Article  PubMed Central  Google Scholar 

  34. 34.

    Berte B, Relan J, Sacher F et al (2015) Impact of electrode type on mapping of scar-related VT. J Cardiovasc Electrophysiol 26:1213–1223

    PubMed  Article  PubMed Central  Google Scholar 

  35. 35.

    Hutchinson MD, Gerstenfeld EP, Desjardins B et al (2011) Endocardial unipolar voltage mapping to detect epicardial ventricular tachycardia substrate in patients with nonischemic left ventricular cardiomyopathy. Circ Arrhythmia Electrophysiol 4:49–55

    Article  Google Scholar 

  36. 36.

    Aziz Z, Shatz D, Raiman M et al (2019) Targeted ablation of ventricular tachycardia guided by wavefront discontinuities during sinus rhythm. Circulation 140:1383–1397

    PubMed  Article  PubMed Central  Google Scholar 

  37. 37.

    Pothineni NV, Deshmukh A, Padmanabhan D et al (2015) Complication rates of ventricular tachycardia ablation: comparison of safety outcomes derived from administrative databases and clinical trials. Int J Cardiol 201:529–531

    PubMed  Article  PubMed Central  Google Scholar 

  38. 38.

    Santangeli P, Muser D, Zado ES et al (2015) Acute hemodynamic decompensation during catheter ablation of scar-related ventricular tachycardia: incidence, predictors, and impact on mortality. Circ Arrhythm Electrophysiol 8:68–75

    PubMed  Article  PubMed Central  Google Scholar 

  39. 39.

    Palaniswamy C, Kolte D, Harikrishnan P et al (2014) Catheter ablation of postinfarction ventricular tachycardia: ten-year trends in utilization, in-hospital complications, and in-hospital mortality in the United States. Heart Rhythm 11:2056–2063

    PubMed  Article  PubMed Central  Google Scholar 

  40. 40.

    Katz DF, Turakhia MP, Sauer WH et al (2015) Safety of ventricular tachycardia ablation in clinical practice: findings from 9699 hospital discharge records. Circ Arrhythmia Electrophysiol 8:362–370

    Article  Google Scholar 

  41. 41.

    Ren JF, Marchlinski FE (2010) Early detection of iatrogenic pericardial effusion: importance of intracardiac echocardiography. JACC Cardiovasc Interv 3:127

    PubMed  Article  PubMed Central  Google Scholar 

  42. 42.

    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

    PubMed  Article  PubMed Central  Google Scholar 

  43. 43.

    Jackson N, McGee M, Ahmed W et al (2018) Groin haemostasis with a purse string suture for patients following catheter ablation procedures (GITAR study). Heart Lung Circ. https://doi.org/10.1016/j.hlc.2018.03.011

    Article  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Pracon R, Bangalore S, Henzel J et al (2018) A randomized comparison of modified subcutaneous “Z”-stitch versus manual compression to achieve hemostasis after large caliber femoral venous sheath removal. Catheter Cardiovasc Interv 91:105–112

    PubMed  Article  PubMed Central  Google Scholar 

  45. 45.

    Ben-Dor I, Craig P, Torguson R et al (2018) Mynx. Grip vascular closure device versus manual compression for hemostasis of percutaneous transfemoral venous access closure: results from a prospective multicenter randomized study. Cardiovasc Revasc Med 19:418–422

    PubMed  Article  PubMed Central  Google Scholar 

  46. 46.

    Jiang J, Zou J, Ma H et al (2015) Network meta-analysis of randomized trials on the safety of vascular closure devices for femoral arterial puncture site haemostasis. Sci Rep 5:13761

    PubMed  PubMed Central  Article  Google Scholar 

  47. 47.

    Bella DP, Brugada J, Zeppenfeld K et al (2011) Epicardial ablation for ventricular tachycardia: a European multicenter study. Circ Arrhythm Electrophysiol 4:653–659

    PubMed  Article  PubMed Central  Google Scholar 

  48. 48.

    Dyrda K, Piers SR, van Huls van Taxis CF, Schalij MJ, Zeppenfeld K (2014) Influence of steroid therapy on the incidence of pericarditis and atrial fibrillation after percutaneous epicardial mapping and ablation for ventricular tachycardia. Circ Arrhythm Electrophysiol 7:671–676

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  49. 49.

    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

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  50. 50.

    Marchlinski FE, Haffajee CI, Beshai JF et al (2016) Long-term success of irrigated radiofrequency catheter ablation of sustained ventricular tachycardia: post-approval THERMOCOOL VT trial. J Am Coll Cardiol 67:674–683

    PubMed  Article  PubMed Central  Google Scholar 

  51. 51.

    Latchamsetty R, Yokokawa M, Morady F et al (2015) Multicenter outcomes for catheter ablation of idiopathic premature ventricular complexes. JACC Clin Electrophysiol 1:116–123

    PubMed  Article  PubMed Central  Google Scholar 

  52. 52.

    Peichl P, Wichterle D, Pavlu L, Cihak R, Aldhoon B, Kautzner J (2014) Complications of catheter ablation of ventricular tachycardia: a single center experience. Circ Arrhythm Electrophysiol 7:684–690

    PubMed  Article  PubMed Central  Google Scholar 

  53. 53.

    Santangeli P, Frankel DS, Tung R et al (2017) Early mortality after catheter ablation of ventricular tachycardia in patients with structural heart disease. J Am Coll Cardiol 69:2105–2115

    PubMed  Article  PubMed Central  Google Scholar 

  54. 54.

    Liang JJ, Kodali S, Schaller RD, Birati EY, Marchlinski FE, Santangeli P (2018) Intraprocedural slow continuous ultrafiltration: a novel strategy to prevent acute hemodynamic decompensation from volume overload during VT ablation. Pacing Clin Electrophysiol 41:1043–1044

    Article  Google Scholar 

  55. 55.

    Turagam MK, Vuddanda V, Atkins D et al (2017) Hemodynamic support in ventricular tachycardia ablation: an International VT Ablation Center Collaborative Group study. JACC Clin Electrophysiol 3:1534–1543

    PubMed  Article  PubMed Central  Google Scholar 

  56. 56.

    Muser D, Liang JJ, Castro SA et al (2018) Outcomes with prophylactic use of percutaneous left ventricular assist devices in high-risk patients undergoing catheter ablation of scar-related VT: a propensity-matched analysis. Heart Rhythm 15:1500–1506

    PubMed  Article  PubMed Central  Google Scholar 

  57. 57.

    Mathuria N, Wu G, Rojas-Delgado F et al (2017) Outcomes of pre-emptive and rescue use of percutaneous left ventricular assist device in patients with structural heart disease undergoing catheter ablation of ventricular tachycardia. J Interv Card Electrophysiol 48:27–34

    PubMed  Article  PubMed Central  Google Scholar 

  58. 58.

    Reddy YM, Chinitz L, Mansour M et al (2014) Percutaneous left ventricularassist devices in ventricular tachycardia ablation: multicenter experience. Circ Arrhythm Electrophysiol 7:244–250

    PubMed  PubMed Central  Article  Google Scholar 

  59. 59.

    Piccione W Jr, Goldin MD (1988) Mitral valve dysfunction following papillary muscle cryoablation. Ann Thorac Surg 46:347–348

    PubMed  Article  PubMed Central  Google Scholar 

  60. 60.

    Tokuda M, Tedrow UB, Kojodjojo P et al (2012) Cather ablation of ventricular tachycardia in nonischemic heart disease. Circ Arrhythm Electrophysiol 5:992–1000

    PubMed  Article  PubMed Central  Google Scholar 

  61. 61.

    Seto AH, Abu-Fadel MS, Sparling JM et al (2010) Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Arterial Access With Ultrasound Trial). J Am Coll Cardiol Interv 3:751–758

    Article  Google Scholar 

  62. 62.

    Biancari F, D’Andrea V, Di Marco C, Savino G, Tiozzo V, Catania A (2010) Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty. Am Heart J 159:518–531

    PubMed  Article  PubMed Central  Google Scholar 

  63. 63.

    Nikolsky E, Mehran R, Halkin A et al (2004) Vascular complications associated with arteriotomy closure devices in patients undergoing percutaneous coronary procedures: a meta-analysis. J Am Coll Cardiol 44:1200–1209

    PubMed  PubMed Central  Google Scholar 

  64. 64.

    Jongbloed MR, Bax JJ, van der Burg AE, van der Wall EE, Schalij MJ (2004) Radiofrequency catheter ablation of ventricular tachycardia guided by intracardiac echocardiography. Eur J Echocardiogr 5:34–40

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  65. 65.

    Desimone CV, Hu T, Ebrille E et al (2014) Catheter ablation related mitral valve injury: the importance of early recognition and rescue mitral valve repair. J Cardiovasc Electrophysiol 25:971–975

    PubMed  PubMed Central  Article  Google Scholar 

  66. 66.

    Frankel DS, Mountantonakis SE, Zado ES, Anter E, Bala R, Cooper JM, Deo R, Dixit S, Epstein AE, Garcia FC, Gerstenfeld EP, Hutchinson MD, Lin D, Patel VV, Riley MP, Robinson MR, Tzou WS, Verdino RJ, Callans DJ, Marchlinski FE (2012) Noninvasive programmed stimulation early after ventricular tachycardia ablation to predict risk of late recurrence. J Am Coll Cardiol 59:1529–1535

    PubMed  Article  PubMed Central  Google Scholar 

  67. 67.

    Oloriz T, Baratto F, Trevisi N, Barbaro M, Bisceglia C, D’Angelo G, Yamase M, Paglino G, Radinovic A, Bella DP (2018) Defining the outcome of ventricular tachycardia ablation. Timing and value of programmed ventricular stimulation. Circ Arrhythm Electrophysiol 11:e5602

    PubMed  Article  PubMed Central  Google Scholar 

  68. 68.

    Frontera A, Kalinsek TP, Hadjis A, Delle Bella P (2020) Noninvasive programmed stimulation in the setting of ventricular tachycardia catheter ablation. J Cardiovasc Electrophysiol 31:1828–1835

    PubMed  Article  PubMed Central  Google Scholar 

  69. 69.

    Souissi Z, Boule S, Hermida JS et al (2018) Catheter ablation reduces ventricular tachycardia burden in patients with arrhythmogenic right ventricular cardiomyopathy: insights from a north-western French multicentre registry. Europace 20:362–369

    PubMed  Article  PubMed Central  Google Scholar 

  70. 70.

    Guerra F, Shkoza M, Scappini L, Flori M, Capucci A (2014) Role of electrical storm as a mortality and morbidity risk factor and its clinical predictors: a meta-analysis. Europace 16:347–353

    PubMed  Article  PubMed Central  Google Scholar 

  71. 71.

    Anker SD, Agewall S, Borggrefe M et al (2014) The importance of patient-reported outcomes: a call for their comprehensive integration in cardiovascular clinical trials. Eur Heart J 35:2001–2009

    PubMed  Article  PubMed Central  Google Scholar 

  72. 72.

    Stehlik J, Estep JD, Selzman CH et al (2017) ROADMAP Study Investigators: Patient-reported health-related quality of life is a predictor of outcomes in ambulatory heart failure patients treated with left ventricular assist device compared with medical management: results from the ROADMAP Study (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management). Circ Heart Fail 10:e3910

    PubMed  PubMed Central  Google Scholar 

  73. 73.

    Steinbeck G, Sinner MF, Lutz M, Müller-Nurasyid M, Kääb S, Reinecke H (2018) Incidence of complications related to catheter ablation of atrial fibrillation and atrial flutter : a nationwide in-hospital analysis of administrative data for Germany in 2014. Eur Heart J 39:4020–4029

    PubMed  PubMed Central  Article  Google Scholar 

  74. 74.

    Deshmuk A, Patel NJ, Pant S, Shah N, Chothani A, Mehta K, Grover P, Singh V, Vallurupalli S, Savani GT, Badheka A, Tuliani T, Dabhadkar K, Dibu G, Reddy YM, Sewani A, Kowalski M, Mitrani R, Paydak H, Viles-Gonzales JF (2013) In-hospital complications associated with catheter ablation of atrial fibrillation in the United States between 2000 and 2010 : analysis of 93801 procedures. Circulation 128:2104–2112

    Article  Google Scholar 

  75. 75.

    Maury P et al (2019) Position paper concerning the competence, performance and environment required in the practice of complex ablation procedures. Arch Cardiovasc Dis 112:67–73

    PubMed  Article  PubMed Central  Google Scholar 

  76. 76.

    Sacher F, Roberts-Thomson K, Maury P, Tedrow U, Nault I, Steven D, Hocini M, Koplan B, Leroux L, Derval N, Seiler J, Wright MJ, Epstein L, Haissaguerre M, Jais P, Stevenson WG (2010) Epicardial ventricular tachycardia ablation : a multicenter safety study. J Am Coll Cardiol 55:2366–2372

    PubMed  Article  PubMed Central  Google Scholar 

  77. 77.

    Arevalo HJ, Vadakkumpadan F, Guallar E, Jebb S, Malamas P, Wu KC, Trayanova NA (2016) Arrhythmie risk stratification of patients after myocardial infarction using personalized heart models. Nat Commun 7:11437

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  78. 78.

    Stevenson WG, Tedrow UB, Reddy V, AbdelWahab A, Dukkipati S, John RM, Fujii A, Schaeffer B, Tanigawa S, Elsokkari I, Koruth J, Nakamura T, Naniwadekar A, Ghidoli D, Pellegrini C, Sapp JL (2019) Infusion needle radiofrequency abaltion for treatment of refractory ventricular arrhythmias. J Am Coll Cardiol 73:1413–1425

    PubMed  Article  PubMed Central  Google Scholar 

  79. 79.

    Koruth JS, Kuroki K, Iwasawa J, Viswanathan R, Brose R, Buck ED, Dosnkoy E, Dukkipati SR, Reddy VY (2020) Endocardial ventricular pulsed field ablation: a proof-of-concept preclinical evaluation. Europace 22:434–439

    PubMed  Article  PubMed Central  Google Scholar 

  80. 80.

    Cuculich PS, Schill MR, Kashani R, Mutic S, Lang A, Cooper D, Faddis M, Gleva M, Noheria A, Smith TW, Hallahan D, Rudy Y, Robinson CG (2017) Noninvasive cardiac radiation for ablation of ventricular tachycardia. N Engl J Med 377:2325–2336

    PubMed  PubMed Central  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Prof. Dr. Thomas Deneke.

Ethics declarations

Interessenkonflikt

Den Interessenkonflikt der Autoren finden Sie online auf der DGK-Homepage unter http://leitlinien.dgk.org/ bei der entsprechenden Publikation.

Additional information

Aus Gründen der besseren Lesbarkeit und Verständlichkeit der Texte wird in Springer-Publikationen in der Regel das generische Maskulinum als geschlechtsneutrale Form verwendet. Diese Form impliziert immer alle Geschlechter.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Deneke, T., Bosch, R., Deisenhofer, I. et al. Empfehlung der Deutschen Gesellschaft für Kardiologie zur Katheterablation ventrikulärer Arrhythmien. Kardiologe 15, 38–56 (2021). https://doi.org/10.1007/s12181-020-00440-x

Download citation

Schlüsselwörter

  • Substratmodifikation
  • Herzinsuffizienz
  • VT-Einheit
  • Epikardiale Ablation
  • VT-Zentrum
  • Hochauflösendes Mapping
  • Indikationen
  • Idiopathische VT

Keywords

  • Substrate modification
  • Heart failure
  • VT unit
  • Epicardial ablation
  • VT-center
  • High-density mapping
  • Imaging
  • Idiopathic VT