How to Evaluate for and Manage Inflammatory and Infiltrative Cardiomyopathies that Require Ventricular Tachycardia Ablation

AbstractPurpose of ReviewVentricular arrhythmias (VAs) are a significant cause of morbidity and mortality in patients with cardiomyopathy (CM). This review focuses on ventricular tachycardia (VT) management in uncommon causes of heart disease, such as inflammatory and infiltrative CMs.Recent FindingsIntegration of advanced cardiac imaging modalities, such as cardiac magnetic resonance imaging (MRI) and positron emission tomography (PET), into diagnostic evaluation of patients with CM may unmask abnormal myocardial substrate in almost half of patients presenting with VAs. Stepwise approach to management of VAs in cardiac sarcoidosis (CS) includes use of immunosuppressive therapy during active inflammatory phase and reserves radiofrequency catheter ablation (RFCA) for later fibrotic phase of the disease. Recurrences of VT are common, but reduction in VA burden can be achieved in up to 90% of patients after RFCA. VAs in patients with acute nonchagasic myocarditis often resolve with supportive therapy and treatment of heart failure. RFCA in chagasic myocarditis is typically used for patients with sustained monomorphic VT who do not respond to antiarrhythmic medications. Basal inferolateral scar is a common arrhythmia substrate, while at least a third of reentrant circuits are epicardial. Upfront combined epicardial and endocardial approach should be considered in all patients with chagasic myocarditis. VAs in cardiac amyloidosis tend to be focal and respond well to catheter ablat...
Source: Current Cardiovascular Risk Reports - Category: Cardiology Source Type: research