2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias
Edmond M Cronin1, Frank M Bogun2, Philippe Maury3
1Hartford Hospital, Hartford, CT, USA. clinicaldocs@hrsonline.org.
Insights
New guidelines offer updated best practices for catheter ablation of ventricular arrhythmias. This expert consensus document aims to improve patient selection, procedural safety, and outcomes for tachycardia and fibrillation management.
Area of Science:
- Cardiac Electrophysiology
- Interventional Cardiology
- Arrhythmology
Background:
- Ventricular arrhythmias (VAs) are significant causes of patient morbidity and mortality.
- Recent advancements in understanding, diagnosing, and treating VAs necessitate updated guidelines.
- Catheter ablation techniques and technologies have notably progressed over the last decade.
Purpose of the Study:
- To provide updated recommendations and best practices for catheter ablation of VAs.
- To replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias.
- To guide electrophysiologists in patient selection, procedural execution, and follow-up care.
Main Methods:
- An expert writing group reviewed and discussed existing literature, including a systematic review and meta-analysis.
- Recommendations were drafted, voted upon, and based on current knowledge and expert experience.
- Content includes knowledge byte recommendations, supportive text, references, and practical synopses of techniques and substrates.
Main Results:
- The document summarizes current knowledge and practice in catheter ablation for VAs.
- It provides a practical overview of techniques for various VA sites and substrates.
- Recommendations are presented in a clear, accessible format for clinical application.
Conclusions:
- This consensus document offers a comprehensive update on catheter ablation for ventricular arrhythmias.
- It aims to enhance the safety and efficacy of procedures, leading to improved patient outcomes.
- It serves as a crucial resource for electrophysiologists globally in managing complex VAs.
Abstract:
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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