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Published in: Current Treatment Options in Cardiovascular Medicine 5/2024

Open Access 25-04-2024 | Ventricular Tachycardia | Review

Challenges in Ventricular Arrhythmia Ablation: Difficult Substrates and Advanced Ablation Strategies

Authors: Łukasz Zarębski, MD, Piotr Futyma, MD, PhD, FESC, FEHRA

Published in: Current Treatment Options in Cardiovascular Medicine | Issue 5/2024

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Abstract

Purpose of review

During challenging scenarios of ventricular arrhythmia (VA) ablation, novel strategies to target the arrhythmogenic substrate are sometimes essential for clinical success. While catheter ablation (CA) can offer relatively high efficacy, it may not always lead to complete VA eradication in certain individuals. This article provides a brief overview of difficult substrate ablation strategies in patients with premature ventricular contractions (PVC) or ventricular tachycardia (VT) and explores methods to improve outcomes for cases that do not respond to typical ablation techniques.

Recent findings

Recent developments highlight the crucial role of advanced imaging and mapping techniques in the visualization, characterization, and localization of challenging ventricular substrates. Additionally, some novel and advanced ablation strategies may be useful when PVC/VT is refractory to conventional ablation treatment.

Summary

An expanding spectrum of techniques which can optimize the precision and effectiveness of catheter ablation procedures may improve PVC/VT ablation outcomes. Novel ablation therapies such as alcohol ablation, optimization of dispersive patch positions, or bipolar ablation, can overcome obstacles associated with the challenging anatomy of arrhythmia.
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Metadata
Title
Challenges in Ventricular Arrhythmia Ablation: Difficult Substrates and Advanced Ablation Strategies
Authors
Łukasz Zarębski, MD
Piotr Futyma, MD, PhD, FESC, FEHRA
Publication date
25-04-2024
Publisher
Springer US
Published in
Current Treatment Options in Cardiovascular Medicine / Issue 5/2024
Print ISSN: 1092-8464
Electronic ISSN: 1534-3189
DOI
https://doi.org/10.1007/s11936-024-01036-4