Ablation options for sub-epicardially located ventricular substrates responsible for ventricular tachycardia: where is it all headed?

IF 2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Opinion in Cardiology Pub Date : 2025-01-01 Epub Date: 2024-10-09 DOI:10.1097/HCO.0000000000001184

Jason S Sperling, Pasquale Santangeli

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引用次数: 0

Abstract

Purpose of review: Patients with nonischemic and ischemic cardiomyopathy (NICM and ICM) exhibit re-entrant tachycardias related to scar tissue in subepicardial, in addition to typical subendocardial locations. Control of ventricular arrhythmias related to these targets has remained elusive despite advances in mapping and ablation technology.

Recent findings: Percutaneous epicardial ablation is the standard after failed endocardial ventricular ablation, but recurrence rates are disappointing. Pulsed-field energy has been associated with coronary artery spasm and therefore may be less suitable for epicardial ablation. Commercially available energy sources, including pulsed-field, have limited depths of myocardial penetration when applied epicardially. Lateral volumetric thermal spreading of ablation injury is associated with decreasing depth of ablation and is difficult to control. A new cryoablation technology based on liquid helium and developed specifically for epicardial work may be able to overcome these limitations.

Summary: Ablation strategies that can improve lesion formation in subepicardial ventricular myocardium may improve outcomes of ablation in nonsubendocardial NICM and ICM targets.

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心外膜下心室基质导致室速的消融方案：何去何从？

审查目的：非缺血性和缺血性心肌病（NICM 和 ICM）患者除典型的心内膜下位置外，还表现出与心外膜下瘢痕组织有关的再电位心动过速。尽管制图和消融技术不断进步，但与这些靶点相关的室性心律失常仍难以控制：最近的研究结果：经皮心外膜消融是心内膜心室消融失败后的标准方法，但复发率令人失望。脉冲场能量与冠状动脉痉挛有关，因此可能不太适合心外膜消融。包括脉冲场在内的市售能量源在心外膜应用时穿透心肌的深度有限。消融损伤的侧向体积热扩散与消融深度下降有关，而且难以控制。摘要：能改善心外膜下心室心肌病变形成的消融策略可改善非心内膜下 NICM 和 ICM 目标消融的疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Cardiology 医学-心血管系统

CiteScore

4.20

自引率

4.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Current Opinion in Cardiology is a bimonthly publication offering a unique and wide ranging perspective on the key developments in the field. Each issue features hand-picked review articles from our team of expert editors. With fourteen disciplines published across the year – including arrhythmias, molecular genetics, HDL cholesterol and clinical trials – every issue also contains annotated reference detailing the merits of the most important papers.