Exploring the Full Potential of Radiofrequency Technology: A Practical Guide to Advanced Radiofrequency Ablation for Complex Ventricular Arrhythmias.

IF 3.1 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Current Cardiology Reports Pub Date : 2024-05-01 Epub Date: 2024-05-03 DOI:10.1007/s11886-024-02048-z
J B Tonko, P Lambiase
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引用次数: 0

Abstract

Purpose of review: Percutaneous radiofrequency (RF) catheter ablation is an established strategy to prevent ventricular tachycardia (VT) recurrence and ICD shocks. Yet delivery of durable lesion sets by means of traditional unipolar radiofrequency ablation remains challenging, and left ventricular transmurality is rarely achieved. Failure to ablate and eliminate functionally relevant areas is particularly common in deep intramyocardial substrates, e.g. septal VT and cardiomyopathies. Here, we aim to give a practical-orientated overview of advanced and emerging RF ablation technologies to target these complex VT substrates. We summarize recent evidence in support of these technologies and share experiences from a tertiary VT centre to highlight important "hands-on" considerations for operators new to advanced RF ablation strategies.

Recent findings: A number of innovative and modified radiofrequency ablation approaches have been proposed to increase energy delivery to the myocardium and maximize RF lesion dimensions and depth. These include measures of impedance modulation, combinations of simultaneous unipolar ablations or true bipolar ablation, intramyocardial RF delivery via wires or extendable RF needles and investigational linear or spherical catheter designs. Recent new clinical evidence for the efficacy and safety of these investigational technologies and strategies merits a re-evaluation of their role and clinic application for percutaneous VT ablations. Complexity of substrates targeted with percutaneous VT ablation is increasing and requires detailed preprocedural imaging to characterize the substrate to inform the procedural approach and selection of ablation technology. Depending on local experience, options for additional and/or complementary interventional treatments should be considered upfront in challenging substrates to improve the success rates of index procedures. Advanced RF technologies available for clinical VT ablations include impedance modulation via hypotonic irrigation or additional dispersive patches and simultaneous unipolar as well as true bipolar ablation. Promising investigational RF technologies involve an extendable needle RF catheter, intramyocardial RF delivery over intentionally perforated wires as well as a variety of innovative ablation catheter designs including multipolar linear, spherical and partially insulated ablation catheters.

Abstract Image

探索射频技术的全部潜力:高级射频消融治疗复杂室性心律失常实用指南》。
审查目的:经皮射频(RF)导管消融是预防室性心动过速(VT)复发和 ICD 电击的既定策略。然而,通过传统的单极射频消融来提供持久的病灶组仍然具有挑战性,而且很少能实现左室透射性。无法消融和消除功能相关区域的情况在心内膜深层基质(如室间隔 VT 和心肌病)中尤为常见。在此,我们将以实用为导向,概述针对这些复杂 VT 基底面的先进和新兴射频消融技术。我们总结了支持这些技术的最新证据,并分享了一家三级 VT 中心的经验,以强调新近采用先进射频消融策略的操作者在 "实践 "中的重要注意事项:最近的研究结果:人们提出了许多创新和改进的射频消融方法,以增加向心肌输送的能量,并最大限度地增加射频病灶的尺寸和深度。这些方法包括阻抗调制措施、同时单极消融或真正双极消融的组合、通过导线或可延伸射频针进行心肌内射频传输,以及研究性线性或球形导管设计。最近有新的临床证据表明,这些研究性技术和策略的有效性和安全性值得重新评估其在经皮 VT 消融中的作用和临床应用。经皮 VT 消融术所针对的基质越来越复杂,需要详细的术前成像来确定基质的特征,为手术方法和消融技术的选择提供依据。根据当地经验,对于具有挑战性的基底,应预先考虑额外和/或辅助介入治疗的方案,以提高指数手术的成功率。可用于临床 VT 消融的先进射频技术包括通过低渗灌注或额外的分散贴片进行阻抗调制,以及同时进行单极和真正的双极消融。前景看好的研究性射频技术包括可伸展的针式射频导管、通过有意穿孔的导线进行心肌内射频传输以及各种创新的消融导管设计,包括多极线性、球形和部分绝缘消融导管。
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来源期刊
Current Cardiology Reports
Current Cardiology Reports CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
6.20
自引率
2.70%
发文量
209
期刊介绍: The aim of this journal is to provide timely perspectives from experts on current advances in cardiovascular medicine. We also seek to provide reviews that highlight the most important recently published papers selected from the wealth of available cardiovascular literature. We accomplish this aim by appointing key authorities in major subject areas across the discipline. Section editors select topics to be reviewed by leading experts who emphasize recent developments and highlight important papers published over the past year. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research. We also provide commentaries from well-known figures in the field.
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