State-of-the-Art Review on VT Ablation in Non-Ischemic Cardiomyopathy (JACC: Clinical Electrophysiology September 2018) is organized by American College of Cardiology (ACC).
Date of Release: September 17, 2018
Term of Approval/Date of CME/MOC Expiration: September 16, 2019
JACC Journal CME/MOC is intended for physicians who treat patients with cardiovascular disease.
Catheter ablation is being increasingly performed as adjunctive treatment to prevent recurrent implantable cardioverter defibrillator (ICD) therapies in patients with non-ischemic cardiomyopathy (NICM) and ventricular tachycardia (VT). In the context of VT ablation, NICM usually refers to dilated cardiomyopathy (DCM) as one morphological phenotype. Over the last decades progress has been made to better characterize distinct subtypes and to differentiate between etiologies of DCM, which has important practical and prognostic implications. The goal of this review is to summarize available data on VT ablation in patients with DCM and, more specifically, review data on procedural and outcome data in specific etiologies and substrate locations. It will focus on our current understanding of non-ischemic scars, as well as the value of multimodal imaging, image-integration and electroanatomical mapping for substrate identification, procedural planning and ablation. In addition, recent findings from whole human heart histology of patients with DCM and VT and their potential implications for imaging and mapping will be discussed.
After reading this article the reader should be able to:
• Identify the different underlying etiologies and typical substrates for VT in patients with non- ischemic cardiomyopathy.
• Recognize the advantages and limitations of the 12-lead ECG, pre-procedural and intra-procedural imaging and bipolar- and unipolar voltage mapping for identifying the VT substrate.
• Select the most appropriate ablation approach for different substrate locations and understand the acute and long-term ablation outcome for different non-ischemic etiologies and substrates.
Additional details will be posted as soon as they are available.
Cardiology, Clinical Cardiac Electrophysiology