INTRODUCTION: Catheter ablation of ventricular tachycardia (VT) is proven effective therapy particularly in patients with frequent defibrillator shocks. However, the optimal endpoint for VT ablation has been debated and additional endpoints have been proposed. At the same time, ablation strategies aiming at homogenizing the substrate of scar-related VT have been reported. METHODS AND RESULTS: Our method to homogenize the substrate consists of local abnormal ventricular activity (LAVA) elimination. LAVA are high-frequency sharp signals that represent near-field signals of slowly conducting tissue and hence potential VT isthmuses. Pacing maneuvers are sometimes required to differentiate them from far-field signals. Delayed enhancement on cardiac MRI and/or wall thinning on multidetector computed tomography are also extremely helpful to identify the areas of interest during ablation. A strategy aiming at careful LAVA mapping, ablation, and elimination is feasible and can be achieved in about 70% of patients with scar-related VT. Complete LAVA elimination is associated with a better outcome when compared to LAVA persistence even when VT is rendered noninducible. CONCLUSION: This is a simple approach, with a clear endpoint and the ability to ablate in sinus rhythm. This strategy significantly benefits from high-definition imaging, mapping, and epicardial access.
INTRODUCTION: Catheter ablation of ventricular tachycardia (VT) is proven effective therapy particularly in patients with frequent defibrillator shocks. However, the optimal endpoint for VT ablation has been debated and additional endpoints have been proposed. At the same time, ablation strategies aiming at homogenizing the substrate of scar-related VT have been reported. METHODS AND RESULTS: Our method to homogenize the substrate consists of local abnormal ventricular activity (LAVA) elimination. LAVA are high-frequency sharp signals that represent near-field signals of slowly conducting tissue and hence potential VT isthmuses. Pacing maneuvers are sometimes required to differentiate them from far-field signals. Delayed enhancement on cardiac MRI and/or wall thinning on multidetector computed tomography are also extremely helpful to identify the areas of interest during ablation. A strategy aiming at careful LAVA mapping, ablation, and elimination is feasible and can be achieved in about 70% of patients with scar-related VT. Complete LAVA elimination is associated with a better outcome when compared to LAVA persistence even when VT is rendered noninducible. CONCLUSION: This is a simple approach, with a clear endpoint and the ability to ablate in sinus rhythm. This strategy significantly benefits from high-definition imaging, mapping, and epicardial access.
Authors: Phillip S Cuculich; Matthew R Schill; Rojano Kashani; Sasa Mutic; Adam Lang; Daniel Cooper; Mitchell Faddis; Marye Gleva; Amit Noheria; Timothy W Smith; Dennis Hallahan; Yoram Rudy; Clifford G Robinson Journal: N Engl J Med Date: 2017-12-14 Impact factor: 91.245
Authors: Elad Anter; Petr Neuzil; Vivek Y Reddy; Jan Petru; Kyoung-Min Park; Jakub Sroubek; Eran Leshem; Peter J Zimetbaum; Alfred E Buxton; Andre G Kleber; Changyu Shen; Andrew L Wit Journal: Circ Arrhythm Electrophysiol Date: 2020-05-06
Authors: Yousra Ghzally; Hasan Imanli; Mark Smith; Jagat Mahat; Wengen Chen; Alejandro Jimenez; Mariem A Sawan; Mohamed Aboel-Kassem F Abdelmegid; Hatem Abd El Rahman Helmy; Salwa Demitry; Vincent See; Stephen Shorofsky; Vasken Dilsizian; Timm Dickfeld Journal: J Nucl Med Date: 2021-04-23 Impact factor: 11.082