New developments in ablation of ventricular arrhythmias

Abstract

In all patients with frequent PVCs, irrespectively of the

presence of structural heart disease, ablation should be considered as all

patients demonstrated significant improvement in LV dimensions, reduction of

NT-proBNP and relieve of symptoms after successful ablation. Not all patients develop LV dysfunction due to frequent PVCs. NT-proBNP might be used to detect patients who might be prone to develop LV dysfunction. Furthermore, fatigue might be a due to increased ventricular wall stress in patients with frequent PVCs. Patients undergoing PVC ablation for frequent idiopathic PVCs are mostly healthy and young. It is therefore important to limit the number of RF applications which can be facilitated by the use of reversed polarity. Real-time image integration with MDCT and CE-MRI improved pre-procedural planning of epicardial ablation, substrate identification and delineation, and can guide to areas containing critical isthmus sites but also identifies inappropriate ablation sites due to coronary arteries and thick epicardial fat layers thereby facilitating successful ablation sites. It was demonstrated that endocardial and combined endocardial-epicardial encircling cryoablation were both not effective in preventing VA in patients after surgical ventricular reconstruction. This is important because the VA circuits may resides beneath the patch material not accessible for catheter ablation.