Indikationen zur Katheterablation ventrikulärer Tachykardien

Zusammenfassung

Die Katheterablation ventrikulärer Arrhythmien hat sich in vielen Zentren zu einem Standardverfahren entwickelt. Es lassen sich sowohl hämodynamisch tolerierte als auch nicht tolerierte VTs effektiv abladieren. Insbesondere bei Patienten mit idiopathischen VTs stellt die Katheterablation ein kuratives Vorgehen dar. Bei Patienten mit struktureller kardialer Grundkrankheit führt die Ablation rezidivierender monomorpher VTs zu einer Reduktion von ventrikulären Arrhythmie-Episoden und sollte frühzeitig durchgeführt werden. Auch eine Ablation bei Patienten mit elektrischem Sturm (gehäuftes Auftreten ventrikulärer Arrhythmien innerhalb von 24 Stunden) kann akut zu einer Rhythmusstabilisierung und langfristig zu einer verbesserten Prognose führen. Zunehmend wird die Ablation monomorpher VTs frühzeitig, z. B. auch nach einer ersten VT-Episode, eingesetzt; ebenso gewinnt die Ablation auch asymptomatischer gehäufter ventrikulärer Extrasystolen zur Beeinflussung der Prognose an Bedeutung.

Abstract

Catheter ablation of ventricular arrhythmia has evolved as a standard procedure in many specialized electrophysiology centers. Patients with hemodynamically stable and unstable VT are amendable to substrate-based ablation strategies. In patients with idiopathic VT catheter ablation may be a curative treatment whereas in patients with structural heart disease ablation leads to reduction in VT episodes. Catheter ablation of electrical storm may acutely lead to rhythm stabilization and may positively affect long-term prognosis. Future aspects of VT ablation may lead to early ablation even after a first episode and ablation of asymptomatic frequent ventricular premature complexes to improve prognosis of patients.

Schlüsselwörter

ventrikuläre Tachykardie - narbenassoziiertes Reentry - elektrischer Sturm - Katheterablation - Substratmodifikation

Key words

ventricular tachycardia - scar-related reentry tachycardia - electrical storm - catheter ablation - substrate modification

• Literatur

• 1 Aliot EM, Stevenson WG, Almendral-Garrote JM et al. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. Europace 2009; 11: 771-817
• 2 Tebbenjohanns J, Willems S, Antz M et al. Kommentar zu den “ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death – executive summary”. Kardiologe 2008; 2: 363-388
• 3 Zipes DP, Camm AJ, Borggrefe M et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Europace 2006; 8: 756-837
• 4 Natale A, Raviele A, Al-Ahmad A et al. Venice Chart Internation Consensus Document on Ventricular Tachycardia/Ventricular Fibrillation Ablation. J Cardiovasc Electrophysiol 2010; 21: 339-379
• 5 Baman TS, Lange DC, Ilq KJ et al. Relationship between burden of premature ventricular complexes and left ventricular function. Heart Rhythm 2010; 7: 865-869
• 6 Sacher F, Tedrow UB, Field ME et al. Ventricular tachycardia ablation: evolution of patients and procedures over 8 years. Circ Arrhythm Electrophysiol 2008; 1: 153-161
• 7 Deneke T, Lawo T, Grewe PH et al. Usefulness of a Limited Ablation of Post-Myocardial Infarction Ventricular Tachycardia Using a Standardized Approach Based on Sinus Rhythm Mapping. Am J Cardiol 2010; 105: 1235-1239
• 8 Stevenson W, Friedman P, Kocovic D et al. Radiofrequency catheter ablation of ventricular tachycardia after myocardial infarction. Circulation 1998; 98: 302-314
• 9 Marchlinski F, Callans D, Gottlieb C et al. Linear Ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy. Circulation 2000; 101: 1288-1296
• 10 Marchlinski FE, Garcia F, Siadatan A et al. Ventricular tachycardia/ventricular fibrillation ablation in the setting of ischemic heart disease. J Cardiovasc Electrophysiol 2005; 16: 59-70
• 11 Arenal A, Glez-Torrecilla E, Ortiz M et al. Ablation of electrograms with an isolated, delayed component as treatment of unmappable monomorphic ventricular tachycardias in patients with structural heart disease. J Am Coll Cardiol 2003; 41: 81-92
• 12 Stevenson WG, Wilber DJ, Natale A. et al. (Multicenter Thermocool VT Ablation Trial Investigators). Irrigated radiofrequency catheter ablation guided by electroanatomic mapping for recurrent ventricular tachycardia after myocardial infarction: the multicenter thermocool ventricular tachycardia ablation trial. Circulation 2008; 118: 2773-2782
• 13 Kleemann T, Hochadel M, Strauss M et al. Comparison between atrial fibrillation-triggered implantable cardioverter-defibrillator (ICD) shocks and inappropriate shocks caused by lead failure: different impact on prognosis in clinical practice. J Cardiovasc Electrophysiol 2012; 23: 735-740
• 14 Reddy VY, Reynolds MR, Neuzil P et al. Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med 2007; 357: 2657-2665
• 15 Deneke T, Shin DI, Lawo T et al. Catheter ablation of electrical storm in a collaborative hospital network. Am J Cardiol 2011; 108: 233-239
• 16 Carbucicchio C, Santamaria M, Trevisi N et al. 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 2008; 117: 462-469