Jan van den Bruck1, Jakob Lüker1, Arian Sultan1, Karlo Filipovic1, Cornelia Scheurlen1, Judith Froch-Cordis2, Daniel Steven3. 1. Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland. 2. Institut für Rechtsmedizin, Uniklinik Köln, Köln, Deutschland. 3. Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland. daniel.steven@uk-koeln.de.
Abstract
BACKGROUND: Catheter ablation of ventricular tachycardias (VTs) is one of the most complex tasks in interventional electrophysiology. It is complicated by the fact that VT can recur during treatment which can affect the hemodynamic stability of the patient. In addition, navigation with the ablation or mapping catheter through the valvular apparatus and the trabecularization of the ventricle can be challenging. MATERIALS AND METHODS: In most cases, a three-dimensional mapping system is used to facilitate orientation and the search for the site where the tachycardia originates. Access to the right ventricle is usually via the tricuspid valve, but in exceptional cases it may also be necessary to use the epicardial venous system. The structures most commonly responsible for an arrhythmia from the right ventricle are the right ventricular outflow tract, the moderator band and the tricuspid valve annulus. The right ventricle is adjacent to vulnerable neighboring structures in many places: In the right ventricular outflow tract, the sinus valsalva, the pulmonary artery and the left ventricular endocardial transition between the aortic and mitral valves must be considered. When ablating along the tricuspid valve annulus, the proximity to the septum and thus to the specific conduction system is particularly important. CONCLUSION: Knowledge of the surrounding structures helps, on the one hand, to draw the right conclusions about the point of origin in the surface ECG, and, on the other hand, to carry out the ablation successfully and safely.
BACKGROUND: Catheter ablation of ventricular tachycardias (VTs) is one of the most complex tasks in interventional electrophysiology. It is complicated by the fact that VT can recur during treatment which can affect the hemodynamic stability of the patient. In addition, navigation with the ablation or mapping catheter through the valvular apparatus and the trabecularization of the ventricle can be challenging. MATERIALS AND METHODS: In most cases, a three-dimensional mapping system is used to facilitate orientation and the search for the site where the tachycardia originates. Access to the right ventricle is usually via the tricuspid valve, but in exceptional cases it may also be necessary to use the epicardial venous system. The structures most commonly responsible for an arrhythmia from the right ventricle are the right ventricular outflow tract, the moderator band and the tricuspid valve annulus. The right ventricle is adjacent to vulnerable neighboring structures in many places: In the right ventricular outflow tract, the sinus valsalva, the pulmonary artery and the left ventricular endocardial transition between the aortic and mitral valves must be considered. When ablating along the tricuspid valve annulus, the proximity to the septum and thus to the specific conduction system is particularly important. CONCLUSION: Knowledge of the surrounding structures helps, on the one hand, to draw the right conclusions about the point of origin in the surface ECG, and, on the other hand, to carry out the ablation successfully and safely.
Authors: Daniel Steven; Kurt C Roberts-Thomson; Jens Seiler; Keiichi Inada; Usha B Tedrow; Richard N Mitchell; Piotr S Sobieszczyk; Andrew C Eisenhauer; Gregory S Couper; William G Stevenson Journal: Circ Arrhythm Electrophysiol Date: 2009-12