Core Concepts in EP Topics: The Tetralogy of Fallot (Reviewers Copy)-Ventricular Tachycardia Substrate Mapping and Ablation

Video Transcription

Video Summary

In summary, Dr. Jeremy Moore discusses ventricular tachycardia (VT) in Tetralogy of Fallot, focusing on substrate mapping and ablation. Early studies identified reentrant mechanisms in the RV outflow tract and septal areas post-operatively. Catheter ablation success was reported in the 1980s, with key isthmuses including the RV outflow tract and septal inflow areas. Modern mapping techniques and three-dimensional mapping aid in identifying critical isthmuses, such as isthmus number 3 between the pulmonary annulus and VSD patch. Utilizing CT scans can assess wall thickness and coronary anatomy for procedural planning. Workflow includes VT entrainment, pace mapping, and confirming bidirectional block post-ablation. Challenges arise post-valve placement covering critical isthmuses. Preemptive EP studies may be beneficial to overcome this issue. In conclusion, substrate-based mapping targeting specific isthmuses remains instrumental in VT ablation for Tetralogy of Fallot.

Keywords

Ventricular tachycardia

Tetralogy of Fallot

Substrate mapping

Ablation

Reentrant mechanisms

Catheter ablation