Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android


General Features of Ventricular Tachycardia Ablation Patients

Patients undergoing ablation for ventricular arrhythmias have somewhat of a bimodal distribution, including those with severe structural heart disease versus other patients with idiopathic ventricular tachycardia (VT) having a structurally normal heart. First, characteristics of the structural heart VT patients include: (1) a very high medical acuity with most being inpatient and often in an intensive care unit (ICU); (2) frequent need for urgent ablation; (3) severe structural heart disease due to 1 or more prior, often large, myocardial infarctions (MIs), or severe nonischemic cardiomyopathy (NICM); (4) most have been implanted with ICDs; (5) many have had cardiac arrest and/or VT or VF storm (≥3 episodes within 24 hours) having received multiple shocks; (6) many are being managed with intravenous antiarrhythmics; (7) consideration for hemodynamic support (intra-aortic balloon pump, percutaneous left ventricular assist device, or extracorporeal membrane oxygenation) is common. On the other hand, a substantial number of VT ablation patients1 have idiopathic ventricular arrhythmias, lacking appreciable structural heart disease. The relative distribution will depend on referral patterns. Origins include the outflow tract region, the conduction system, and papillary muscles. Sustained VT occurs with these foci, but many have PVCs or nonsustained VT.

Indications for Ventricular Arrhythmia Ablation

In general, ventricular arrhythmia ablation is indicated when medical therapy has failed or is not tolerated or not preferred by the patient (Table 18-1). Medical treatment for sustained reentrant VT with dilated (ischemic or nonischemic) cardiomyopathy includes amiodarone or possibly sotalol (if the heart failure or EF depression is not severe). For normal heart ventricular arrhythmia, medical options comprise beta blockers, nondihydropyridine calcium channel blockers, or Class I or III antiarrhythmic agents. Verapamil can be uniquely effective for fascicular VT (see Chapter 8).

TABLE 18-1Indications for ventricular arrhythmia ablation.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.