Characterization by Imaging and High-density Electrophysiology of Substrates and Ventricular Arrhythmias

Download or read book Characterization by Imaging and High-density Electrophysiology of Substrates and Ventricular Arrhythmias written by Benjamin Berte and published by . This book was released on 2015 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Radiofrequency (RF) catheter ablation is an effective treatment strategy for scar-related ventricular tachycardia (VT), resistant to anti-arrhythmic drugs and intracardiac defibrillator (ICD) placement. The goal of this thesis was to better understand and characterize the arrhythmogenic VT substrate in different cardiomyopathic processes: ischaemic cardiomyopathy (ICM), non-ischaemic cardiomyopathy (NICM), arrhythmogenic right ventricular cardiomyopathy (ARVC) and myocarditis. For this purpose, we combined high resolution imaging including different modalities and high resolution electrical mapping to better understand the structure-function relationship. We focused on multiple different aspects of VT ablation as outlined below. The first part of this thesis focuses on the role of multipolar mapping catheters and imaging to analyze their structural and functional relationship. We demonstrated superiority of high density mapping with multipolar mapping on conventional mapping in detection of scar, channels, local abnormal ventricular activity (LAVA) and sensitivity for near field signals. The second part of this thesis focuses on ablation of epicardial VT substrate. We demonstrated the efficacy and safety of epicardial only procedures in a highly selected population. We used imaging to have access to the exact anatomy of the heart, to image the substrate but also to increase the safety of ablation procedures by imaging the phrenic nerve and the coronary artery system. The third part of this thesis focuses on analysis of the mapping and ablation of potential targets for scar-related VT ablation. Within this context, we identified predictors of interesting ablation (LAVA) sites based on preprocedural imaging. We also analyzed the role of alternative strategies such as bipolar ablation, ethanol ablation and irrigated needle ablation to ablate intramural and intraseptal substrate, 18 often resistant ablation targets. Overall, we demonstrate that novel imaging, mapping and ablation techniques potentially improve the outcome of VT ablation.