ABSTRACT
Radiofrequency ablation of complex cardiac arrhythmias has undergone significant evolution in the past decade, with the development of technology enabling better anatomic and electrophysiologic mapping of abnormal cardiac tissue. In this paper, we will discuss the role of pre-procedural and post-procedural multidetector computed tomography, with specific focus on the anatomic assessment of pulmonary vein and left atrial anatomy in the ablation of atrial fibrillation. We will also consider how the integration of both multidetector computed tomography and electroanatomic computer-based imaging may contribute more broadly to the management of a variety of complex ablation procedures.
Subject(s)
Atrial Fibrillation/therapy , Catheter Ablation/methods , Coronary Angiography/methods , Heart/diagnostic imaging , Tomography, Spiral Computed/methods , Aortography , Catheter Ablation/adverse effects , Constriction, Pathologic/diagnostic imaging , Esophagus/diagnostic imaging , Humans , Pulmonary Veins/diagnostic imaging , Radio Waves/adverse effectsABSTRACT
Both ventricular and atrial arrhythmias are commonly encountered in patients with ventricular dysfunction. In fact, roughly half of the deaths occurring in patients with ventricular dysfunction are caused by ventricular arrhythmias. Atrial arrhythmias in this patient population compromise left ventricular filling and if uncontrolled can exacerbate (and in some cases cause) the underlying myopathic process. Consequently, the diagnosis and treatment of these complex, and often life-threatening, arrhythmias is a critical component in the management of congestive heart failure (CHF). As the complexity of pharmacologic and nonpharmacologic antiarrhythmic therapy evolves, it has become increasingly important to understand the potential benefits and limitations of the various treatment modalities in the setting of patients with CHF. The management of arrhythmias in patients with CHF includes conventional drug therapies, as well as therapies directed specifically at treating the arrhythmias that are encountered. The treatment of atrial arrhythmias may include anticoagulation, drugs for rate control, rhythm control, or radiofrequency ablation. The treatment of ventricular arrhythmias, conversely, uses the implantable cardioverter-defibrillator to prevent sudden death, with adjuvant drug therapy or ablation for refractory ventricular tachycardia. This article provides an overview of the current state-of-the-art arrhythmia management in patients with CHF.
