Key result
The choice between an endocardial versus an epicardial approach to target ventricular tachycardia should depend on the patient's underlying disease substrate and the location of the arrhythmogenic substrate.
Preprocedural cardiac MRI and understanding of underlying structural heart disease are critical for selecting the appropriate endocardial or epicardial ablation strategy for ventricular tachycardia.
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Supports MRI-informed substrate assessment before VT ablation; leaves open prospective trials to guide clinical adoption.
Percutaneous catheter ablation has emerged as an effective treatment modality for the management of ventricular tachycardia. Despite years of progress in this field, the role of epicardial mapping and ablation needs to be further refined. In this review, we discuss the relationship between the type of underlying heart disease and the location of the arrythmogenic substrate as it pertains to a procedural approach. We describe the contribution of preprocedural and intraprocedural diagnostic tools for the localisation of the arrhythmogenic substrate, with a special emphasis on cardiac MRI and electrophysiological mapping. In our opinion, the preferred approach to target ventricular tachycardia should depend on the patient's underlying heart disease and the location of scar tissue, which can be best visualised using cardiac MRI.
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Njeim et al. (2015) conducted a review in Ventricular tachycardia. Catheter ablation (endocardial and/or epicardial) was evaluated. The choice between an endocardial versus an epicardial approach to target ventricular tachycardia should depend on the patient's underlying disease substrate and the location of the arrhythmogenic substrate.
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