Katheterablation von ventrikulären Tachykardien

Zusammenfassung

Seit dem letzten Jahrzehnt wurden beträchtliche Fortschritte in der Diagnostik, Verständnis sowie der ablativen Therapie von ventrikulären Tachykardien (VT) erzielt. Elektroanatomische Navigationssysteme erlauben die 3-dimensionale Rekonstruktion der kardialen Anatomie zusammen mit der elektrischen Signatur; für die VT verantwortliche, langsam leitende Myokardbereiche im und um das Narbengewebe können so direkt identifiziert und abladiert werden. In spezialisierten Zentren kann bei mono- und polymorphen VT sowie Kammerflimmern-triggernde VES erfolgreich gemappt und katheterabladiert werden; dies ist mit einer Reduktion der Rezidivrate und Mortalität bei Patienten mit wiederholten ICD-Schocks verbunden. In diesem Artikel wird auf die Einteilung der VT, die aktuellen Techniken des VT-Mappings und der VT-Ablation sowie auf klinische Resultate und Komplikationen nach VT-Ablation an hierfür erfahrenen Zentren eingegangen.

Abstract

Since the last decade important advances in diagnostics, understanding and the ablation techniques of ventricular tachycardia (VT) have been made. Both, patients with idiopathic VT and patients with structural heart disease and scar-related VT undergo VT ablation, that targets the underlying substrate responsible for VT development. Use of 3-dimensional electro-anatomic mapping systems enables identification of scar-related slow conduction sites, that are the critical players in scar-related VT. Successful mapping and ablation of mono- and polymorphic VT and ventricular fibrillation is achieved at specialized centers and is associated with reduced hospitalizations and mortality in patients with recurrent ICD shocks. This article describes the mechanisms of VTs, current mapping and ablation techniques and the results and complications of VT ablation at experienced VT ablation centers.

Schlüsselwörter

idiopathische ventrikuläre Tachykardie - Kammerflimmern - Arrhythmien durch Myokardnarben - langsame Überleitung - Mapping - Ablation

Keywords

idiopathic ventricular tachycardia - ventricular fibrillation - scar-related arrhythmia - slow conduction - mapping - ablation

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