Ablation of Ventricular Outflow Tract Tachycardias

Jackson J. Liang, Elad Anter, Sanjay Dixit

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

Abstract

Although ventricular tachycardia (VT) usually occurs in patients with structural heart disease, it can also occur in patients with structurally normal hearts. In this scenario, the mechanism of VT is usually focal and because of adenosine-sensitive, triggered activity. The right and left ventricular outflow tracts are the most common sites of origin of idiopathic outflow tract VT, including the aortic cusps, pulmonary artery, and left ventricular (LV) summit region. Medications such as beta-blockers, calcium-channel blockers, sodium-channel blockers, and potassium-channel blockers can be effective, but must be taken continually to suppress VT and may have associated long-term side effects. Catheter ablation is a safe and effective treatment option for patients with symptomatic outflow tract VT, and when performed by a skilled electrophysiologist can be considered as first-line treatment. Because of the focal, triggered mechanism of these arrhythmias, activation mapping during arrhythmia is optimal to identify the site of earliest activation as the target for ablation. A comprehensive understanding of the anatomy of the outflow tract region is necessary to maximize safety and efficacy of ablation of outflow tract ventricular arrhythmias. Challenges to ablating outflow tract tachycardias include mapping and ablation of noninducible tachycardias and ablation of tachycardias originating from regions that are difficult to target because of anatomic constraints (including the LV summit region, parahissian, and/or intraseptal location).

Original languageEnglish
Title of host publicationCatheter Ablation of Cardiac Arrhythmias
PublisherElsevier
Pages448-466.e3
ISBN (Electronic)9780323529921
DOIs
StatePublished - 1 Jan 2019
Externally publishedYes

Keywords

  • Ablation
  • Catheter
  • Outflow tract
  • Premature ventricular complex (PVC)
  • Ventricular tachycardia

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