{"title":"Intramural Ventricular Arrhythmias: How to Crack a Hard Nut.","authors":"Matthew Hanson, Andres Enriquez, Fermin Garcia","doi":"10.1007/s11886-024-02143-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose of the review: </strong>Successful catheter ablation of ventricular arrhythmias depends on identifying the critical tissues that sustain the arrhythmia. Increasingly, the intramural space is being recognized as an important source of idiopathic and reentrant ventricular arrhythmias, representing a common cause of ablation failure. A systematic approach to mapping and ablating these arrhythmias is key to optimize outcomes.</p><p><strong>Recent findings: </strong>Intramural ventricular arrhythmias are common in certain anatomical locations such as the left ventricular ostium or the interventricular septum. In these cases, mapping of the septal coronary veins provides an opportunity to explore the intramural compartment of the septum to perform activation mapping, entrainment and/or pace mapping. When an intramural arrhythmia is identified, ablation may require radiofrequency application from multiple sites, prolonged lesions, or special ablation techniques such as bipolar ablation or transvenous ethanol injection. Identification of intramural ventricular arrhythmias depends on comprehensive mapping that should include the coronary venous system, and ablation often requires advanced techniques. This paper provides a guide on when to suspect an intramural ventricular arrhythmia in the electrophysiology laboratory and how to approach mapping and ablation in these challenging cases.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":" ","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current Cardiology Reports","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11886-024-02143-1","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose of the review: Successful catheter ablation of ventricular arrhythmias depends on identifying the critical tissues that sustain the arrhythmia. Increasingly, the intramural space is being recognized as an important source of idiopathic and reentrant ventricular arrhythmias, representing a common cause of ablation failure. A systematic approach to mapping and ablating these arrhythmias is key to optimize outcomes.
Recent findings: Intramural ventricular arrhythmias are common in certain anatomical locations such as the left ventricular ostium or the interventricular septum. In these cases, mapping of the septal coronary veins provides an opportunity to explore the intramural compartment of the septum to perform activation mapping, entrainment and/or pace mapping. When an intramural arrhythmia is identified, ablation may require radiofrequency application from multiple sites, prolonged lesions, or special ablation techniques such as bipolar ablation or transvenous ethanol injection. Identification of intramural ventricular arrhythmias depends on comprehensive mapping that should include the coronary venous system, and ablation often requires advanced techniques. This paper provides a guide on when to suspect an intramural ventricular arrhythmia in the electrophysiology laboratory and how to approach mapping and ablation in these challenging cases.
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.