(FIT)-Module 3 Lectures: Invasive Diagnosis and Treatment Part 2-Ventricular Tachycardia: Ischemic and Nonischemic Cardiomyopathy and Other Unique VT Syndromes (Marchlinski)

Ventricular Tachycardia: Ischemic and Nonischemic Cardiomyopathy and Other Unique VT Syndromes (Marchlinski)

Video Transcription

Video Summary

Frank Marchlinsky from the University of Pennsylvania addresses core concepts in ventricular tachycardia (VT) management, focusing on ischemic and non-ischemic cardiomyopathy, and unique VT syndromes. He outlines two primary VT categories: automatic or triggered focal VTs, often originating from outflow tracts or papillary muscles, where ECGs help pinpoint the arrhythmia source, and reentrant VT circuits, typically scar-related and identifiable by ECG exit points.<br /><br />For managing VT, Marchlinsky emphasizes different clinical approaches. Focal VTs rely on 12-lead ECGs, pace mapping, and activation mapping. Macro-reentrant VTs, especially those in structural heart disease, necessitate entrainment mapping with supplementary activation, pace mapping, and ECG data. He explains how ECG characteristics can indicate VT origins, especially in non-ischemic cardiomyopathy, with specific lead patterns suggesting potential myocardium exits and origin points, aiding in ablation strategy.<br /><br />Marchlinsky notes distinguishing characteristics of focal versus reentrant VTs through pacing responses, highlighting progressive and fixed fusion as indicative of reentrant mechanisms. For scar-related VTs, identifying isthmus sites, characterized by specific activation-stimulation intervals, is crucial for effective ablation.<br /><br />He discusses unique arrhythmias like bundle branch re-entry, fascicular tachycardias, and idiopathic outflow tract VTs, outlining their ECG markers and mapping considerations. Emphasis is placed on evaluating ECG clues and intracardiac features to identify and ablate arrhythmias accurately, leveraging both mapping techniques and ECG analysis to delineate focal points and substrate-related abnormalities.

Keywords

ventricular tachycardia

VT management

ischemic cardiomyopathy

non-ischemic cardiomyopathy

focal VT

reentrant VT

ECG mapping

pace mapping

activation mapping

entrainment mapping

scar-related VT

arrhythmia ablation