Ventricular Tachycardia Ablation in Adult Congenital Heart Disease

Area of Science:

• Cardiology
• Electrophysiology
• Congenital Heart Disease

Background:

• Patients with congenital heart disease (CHD) have an increased risk of developing late ventricular tachycardia (VT) and sudden cardiac death.
• Macroreentrant monomorphic VTs in repaired CHD predominantly arise from slow conducting anatomical isthmuses.
• These isthmuses are bordered by unexcitable tissue from valve annuli, ventricular incisions, or prosthetic materials, creating well-defined ablation targets.

Purpose of the Study:

• To review VT substrates in various forms of CHD.
• To discuss evolving mapping and ablation strategies for VT in CHD.
• To use repaired tetralogy of Fallot as a model for understanding VT substrates and treatment.

Main Methods:

• Review of existing literature on VT in congenital heart disease.
• Analysis of anatomical substrates for macroreentrant VT in repaired CHD.
• Discussion of catheter and surgical ablation techniques.

Main Results:

• Slow conducting isthmuses are the primary substrate for VT in repaired CHD.
• These substrates are amenable to catheter or surgical ablation with clear endpoints.
• Repaired tetralogy of Fallot serves as a representative model for VT substrate and management.

Conclusions:

• Understanding VT substrates in CHD is crucial for preventing sudden cardiac death.
• Advanced mapping and ablation techniques offer effective treatment options.
• Targeting specific anatomical isthmuses provides a clear strategy for VT management in CHD patients.