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Decompensated Heart Failure With Ventricular Arrhythmia: How Useful Is VT Ablation?

  • Decompensated Heart Failure (P Banerjee, Section Editor)
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Abstract

Purpose of Review

Ventricular arrhythmias are common in patients with heart failure. Their management especially in the context of decompensated heart failure poses a clinical challenge to modern cardiologists. In this review article, we aim to summarise the current evidence on the epidemiology, pathophysiology, and management of ventricular tachycardia in heart failure, focusing primarily on the use of catheter ablation.

Recent Findings

The evolution of electro-anatomical mapping techniques and ablation catheter technology in the recent years has paved the path for the successful application of catheter ablation in the treatment of ventricular arrhythmias. The efficacy of catheter ablation in the management of ventricular tachycardia in patients with chronic heart failure has recently been the epicentre of a number of randomised controlled trials, demonstrating promising results with regard to arrhythmia suppression and all-cause mortality. The usefulness of catheter ablation in decompensated heart failure has been explored to a lesser degree, primarily in the setting of an electrical storm.

Summary

Implantable cardiac defibrillators play the most important role in improving prognosis and preventing sudden cardiac death in patients with heart failure. Catheter ablation for the treatment of recurrent VT in patients with chronic heart failure is an efficacious strategy that can be applied adjunctively to or in instead of antiarrhythmic therapy, and it is highly successful at preventing recurrent ventricular tachycardia, ICD shocks. Its efficacy in the context of decompensated heart failure requires further research, with current evidence rendering its use promising.

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  1. Cardiology Department, University Hospital Birmingham, Birmingham, B18 7QH, UK

    Gerasimos Dimitropoulos, Georgios Leventogiannis & Joseph De Bono

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  1. Gerasimos Dimitropoulos
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  2. Georgios Leventogiannis
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  3. Joseph De Bono
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Correspondence to Joseph De Bono.

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Gerasimos Dimitropoulos declares no conflicts of interest.

Georgios Leventogiannis reports support from Biotronik.

Joseph De Bono reports support from Boston Scientific and Biosense.

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This article is part of the Topical Collection on Decompensated Heart Failure

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Dimitropoulos, G., Leventogiannis, G. & De Bono, J. Decompensated Heart Failure With Ventricular Arrhythmia: How Useful Is VT Ablation?. Curr Heart Fail Rep 15, 201–213 (2018). https://doi.org/10.1007/s11897-018-0395-7

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