Best Practices for the Catheter Ablation of Ventricular Arrhythmias

Abstract

Techniques for catheter ablation have evolved to effectively treat a range of ventricular arrhythmias. Pre-operative electrocardiographic and cardiac imaging data are very useful in understanding the arrhythmogenic substrate and can guide mapping and ablation. In this review, we focus on best practices for catheter ablation, with emphasis on tailoring ablation strategies, based on the presence or absence of structural heart disease, underlying clinical status, and hemodynamic stability of the ventricular arrhythmia. We discuss steps to make ablation safe and prevent complications, and techniques to improve the efficacy of ablation, including optimal use of electroanatomical mapping algorithms, energy delivery, intracardiac echocardiography, and selective use of mechanical circulatory support.

Keywords: Catheter ablation; Electroanatomical mapping; Ischemic cardiomyopathy; Nonischemic cardiomyopathy; Patient safety; Substrate ablation; Ventricular arrhythmias; Ventricular tachycardia.