Management of ventricular tachycardia in patients with ischaemic cardiomyopathy: contemporary armamentarium
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Management of ventricular tachycardia in patients with ischaemic cardiomyopathy: contemporary armamentarium. / Kahle, Ann-Kathrin; Jungen, Christiane; Alken, Fares-Alexander; Scherschel, Katharina; Willems, Stephan; Pürerfellner, Helmut; Chen, Shaojie; Eckardt, Lars; Meyer, Christian.
in: EUROPACE, Jahrgang 24, Nr. 4, 05.04.2022, S. 538-551.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
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TY - JOUR
T1 - Management of ventricular tachycardia in patients with ischaemic cardiomyopathy: contemporary armamentarium
AU - Kahle, Ann-Kathrin
AU - Jungen, Christiane
AU - Alken, Fares-Alexander
AU - Scherschel, Katharina
AU - Willems, Stephan
AU - Pürerfellner, Helmut
AU - Chen, Shaojie
AU - Eckardt, Lars
AU - Meyer, Christian
N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.
PY - 2022/4/5
Y1 - 2022/4/5
N2 - Worldwide, ∼4 million people die from sudden cardiac death every year caused in more than half of the cases by ischaemic cardiomyopathy (ICM). Prevention of sudden cardiac death after myocardial infarction by implantation of a cardioverter-defibrillator (ICD) is the most common, even though not curative, therapy to date. Optimized ICD programming should be strived for in order to decrease the incidence of ICD interventions. Catheter ablation reduces the recurrence of ventricular tachycardias (VTs) and is an important adjunct to sole ICD-based treatment or pharmacological antiarrhythmic therapy in patients with ICM, as conclusively demonstrated by seven randomized controlled trials (RCTs) in the last two decades. However, none of the conducted trials was powered to reveal a survival benefit for ablated patients as compared to controls. Whereas thorough consideration of an early approach is necessary following two recent RCTs (PAUSE-SCD, BERLIN VT), catheter ablation is particularly recommended in patients with recurrent VT after ICD therapy. In this context, novel, pathophysiologically driven ablation strategies referring to deep morphological and functional substrate phenotyping based on high-resolution mapping and three-dimensional visualization of scars appear promising. Emerging concepts like sympathetic cardiac denervation as well as radioablation might expand the therapeutical armamentarium especially in patients with therapy-refractory VT. Randomized controlled trials are warranted and on the way to investigate how these translate into improved patient outcome. This review summarizes therapeutic strategies currently available for the prevention of VT recurrences, the optimal timing of applicability, and highlights future perspectives after a PAUSE in BERLIN.
AB - Worldwide, ∼4 million people die from sudden cardiac death every year caused in more than half of the cases by ischaemic cardiomyopathy (ICM). Prevention of sudden cardiac death after myocardial infarction by implantation of a cardioverter-defibrillator (ICD) is the most common, even though not curative, therapy to date. Optimized ICD programming should be strived for in order to decrease the incidence of ICD interventions. Catheter ablation reduces the recurrence of ventricular tachycardias (VTs) and is an important adjunct to sole ICD-based treatment or pharmacological antiarrhythmic therapy in patients with ICM, as conclusively demonstrated by seven randomized controlled trials (RCTs) in the last two decades. However, none of the conducted trials was powered to reveal a survival benefit for ablated patients as compared to controls. Whereas thorough consideration of an early approach is necessary following two recent RCTs (PAUSE-SCD, BERLIN VT), catheter ablation is particularly recommended in patients with recurrent VT after ICD therapy. In this context, novel, pathophysiologically driven ablation strategies referring to deep morphological and functional substrate phenotyping based on high-resolution mapping and three-dimensional visualization of scars appear promising. Emerging concepts like sympathetic cardiac denervation as well as radioablation might expand the therapeutical armamentarium especially in patients with therapy-refractory VT. Randomized controlled trials are warranted and on the way to investigate how these translate into improved patient outcome. This review summarizes therapeutic strategies currently available for the prevention of VT recurrences, the optimal timing of applicability, and highlights future perspectives after a PAUSE in BERLIN.
KW - Arrhythmias, Cardiac/therapy
KW - Cardiomyopathies/surgery
KW - Catheter Ablation/adverse effects
KW - Death, Sudden, Cardiac/prevention & control
KW - Defibrillators, Implantable/adverse effects
KW - Electric Countershock/adverse effects
KW - Humans
KW - Tachycardia, Ventricular/diagnosis
KW - Treatment Outcome
U2 - 10.1093/europace/euab274
DO - 10.1093/europace/euab274
M3 - SCORING: Review article
C2 - 34967892
VL - 24
SP - 538
EP - 551
JO - EUROPACE
JF - EUROPACE
SN - 1099-5129
IS - 4
ER -