2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: executive
Edmond M Cronin1, Frank M Bogun2, Philippe Maury3
1From the Hartford Hospital, Hartford, Connecticut.
Insights
New guidelines offer updated best practices for catheter ablation of ventricular arrhythmias. This expert consensus document aids electrophysiologists in patient selection, procedural safety, and optimal outcomes for ventricular tachycardia and fibrillation.
Area of Science:
- Cardiac Electrophysiology
- Interventional Cardiology
- Arrhythmology
Background:
- Ventricular arrhythmias (VAs) significantly contribute to patient morbidity and mortality.
- Recent advancements in understanding, diagnosing, and treating VAs necessitate updated clinical guidance.
- Catheter ablation techniques and technologies have rapidly evolved, requiring revised best practices.
Purpose of the Study:
- To provide updated recommendations and best practices for catheter ablation of ventricular arrhythmias.
- To replace the 2009 EHRA/HRS Expert Consensus document.
- To guide electrophysiologists in patient selection, procedural execution, and follow-up care.
Main Methods:
- A systematic review and meta-analysis of relevant literature were conducted.
- An expert writing group reviewed and discussed existing evidence and clinical experience.
- Recommendations were drafted, voted upon, and presented in a knowledge byte format.
Main Results:
- The document summarizes current knowledge and practice in catheter ablation for VAs.
- It includes practical synopses of techniques and specific VA substrates.
- Recommendations are supported by evidence and expert consensus.
Conclusions:
- This consensus document provides essential guidance for electrophysiologists performing catheter ablation for VAs.
- It aims to enhance procedural safety, efficacy, and patient outcomes.
- Adherence to these updated guidelines is expected to improve the management of ventricular arrhythmias.
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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