Catheter Ablation of Ventricular Tachycardia in Patients with Structural Heart Disease

by Borggrefe, Martin; Wichter, Thomas; Breithardt, Gunter

• ISBN13: 9780879934651
• ISBN10: 0879934654
• Edition: 1st
• Format: Paperback
• Copyright: 2000-11-02
• Publisher: Wiley-Blackwell

Summary

The exact mechanism of a cardiac arrhythmia becomes fundamentally important when treatment can be directed specifically toward that mechanism. Advances in body surface electrograms and mapping techniques have allowed the causes of ventricular tachyarrhythmias to be pinpointed, thus suggesting viable targets for ablation therapy. However, substantial anatomical and electrophysiological knowledge and catheter-handling skills on the part of the physician are prerequisites for successful ablative technique. Catheter Ablation of Ventricular Tachycardia in Patients with Structural Heart Disease is an in-depth review of this still-expanding subject, presenting both updated information from the current literature and the personal experiences of the authors.The purpose of this book is to provide a comprehensive description of radiofrequency catheter ablation of ventricular tachycardia from history, basic concepts and pathophysiology of radiofrequency lesion formation, to clinical applications and outcomes of these techniques in various subsets of patients with ventricular tachycardia and underlying structural heart disease. Its 128 pages offer a succinct yet comprehensive exchange of information relative to this still-experimental and important field.This book will benefit readers including clinical electrophysiologists, cardiologists, allied industry, and other health care providers who work with patients suffering from ventricular tachycardia.

Author Biography

Martin Borggrefe, MD, is a Professor of Medicine in the Department of Medicine-Cardiology at the University Hospital of Mannheim in Mannheim, Germany.

Günter Breithardt, MD Professor of Medicine (Cardiology), Head, Department of Cardiology and Angiology, Hospital of the University of Münster, Germany.

Table of Contents

Foreword	v
Preface	vii
Introduction	1	(1)
Microscopy and Electrophysiological Anatomy of VT	1	(3)
Types of Energy Used for Ablation	4	(1)
Direct Current Catheter Ablation (``Fulguration'')	5	(4)
Methodology	5	(1)
Mechanisms of DC Ablation	6	(1)
Our Experience	6	(1)
Transient Nature of the Ablative Effects of DC	7	(1)
Complications and Mortality Related to DC Ablation	8	(1)
Chemical Ablation	9	(1)
RF Catheter Ablation of VT	10	(3)
Histologic Evolution of RF Lesions and Subendocardial and Intramural Temperature Response During RF Ablation in Chronic Myocardial Infarction	11	(2)
Modifications of the Conventional RF Ablation Equipment and New Technologies	13	(3)
Localization of the ``Site of Origin'' of VT	16	(10)
Pacing Interventions During VT	26	(17)
Limitations of Pacing Interventions During VT Mapping	43	(1)
Clinical Results of RF Ablation of VT in Patients with Heart Disease	44	(10)
Complications of RF Catheter Ablation	51	(3)
Specific Situations Favoring RF Current Ablation	54	(2)
Incessant VT	54	(2)
RF Catheter Ablation of VT Following Implantation of a Cardioverter-Defibrillator	56	(5)
Catheter Ablation of the Mitral Isthmus for VT Associated with Inferior Myocardial Infarction	58	(1)
Results of Catheter Ablation in Patients with Dilated Cardiomyopathy and Monomorphic VT	59	(2)
Results of Catheter Ablation in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy	61	(12)
Characteristics of the Arrhythmogenic Substrate in ARVC	61	(5)
Endocardial Catheter Mapping of VT in ARVC	66	(2)
Acute and Long-Term Results of Catheter Ablation in ARVC	68	(3)
Specific Situations Favoring Catheter Ablation in ARVC	71	(1)
Localized ARVC	71	(2)
Advances in Mapping of VT	73	(6)
Three-Dimensional Electromagnetic (3-D) Catheter Technology	73	(1)
Noncontact Mapping	74	(3)
Epicardial Mapping of VT	77	(1)
Hemodynamically Unstable VT	78	(1)
Advances in Modifying Energy Sources	79	(3)
Recommendations for Catheter Ablation of VT	82	(2)
Future Perspectives	84	(1)
References	84	(29)
Index	113