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Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jul 26, 2018; 10(7): 52-59
Published online Jul 26, 2018. doi: 10.4330/wjc.v10.i7.52
Novel approaches for the treatment of ventricular tachycardia
Michael Spartalis, Eleftherios Spartalis, Eleni Tzatzaki, Diamantis I Tsilimigras, Demetrios Moris, Christos Kontogiannis, Efthimios Livanis, Dimitrios C Iliopoulos, Vassilis Voudris, George N Theodorakis
Michael Spartalis, ESC Working Group on Cardiac Cellular Electrophysiology, Sophia Antipolis Cedex 06903, France
Michael Spartalis, Eleni Tzatzaki, Efthimios Livanis, Vassilis Voudris, George N Theodorakis, Division of Cardiology, Onassis Cardiac Surgery Center, Athens 17674, Greece
Eleftherios Spartalis, Diamantis I Tsilimigras, Dimitrios C Iliopoulos, Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens 11527, Greece
Demetrios Moris, Department of Surgery, Duke University, Durham, NC 27710, United States
Christos Kontogiannis, Department of Clinical Therapeutics, “Alexandra” Hospital, University of Athens, Athens 11528, Greece
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Michael Spartalis, MD, MSc, PhD, Academic Research, Doctor, Research Fellow, Division of Cardiology, Onassis Cardiac Surgery Center, 356 Syggrou Ave, Athens 17674, Greece. msparta@med.uoa.gr
Telephone: +30-210-9493000 Fax: +30-210-9493000
Received: February 18, 2018
Peer-review started: February 19, 2018
First decision: March 9, 2018
Revised: March 24, 2018
Accepted: June 25, 2018
Article in press: June 27, 2018
Published online: July 26, 2018
Processing time: 157 Days and 13.7 Hours
Abstract

Ventricular tachycardia (VT) is a crucial cause of sudden cardiac death (SCD) and a primary cause of mortality and morbidity in patients with structural cardiac disease. VT includes clinical disorders varying from benign to life-threatening. Most life-threatening episodes are correlated with coronary artery disease, but the risk of SCD varies in certain populations, with various underlying heart conditions, specific family history, and genetic variants. The targets of VT management are symptom alleviation, improved quality of life, reduced implantable cardioverter defibrillator shocks, prevention of reduction of left ventricular function, reduced risk of SCD, and improved overall survival. Antiarrhythmic drug therapy and endocardial catheter ablation remains the cornerstone of guideline-endorsed VT treatment strategies in patients with structural cardiac abnormalities. Novel strategies such as epicardial ablation, surgical cryoablation, transcoronary alcohol ablation, pre-procedural imaging, and stereotactic ablative radiotherapy are an appealing area of research. In this review, we gathered all recent advances in innovative therapies as well as experimental evidence focusing on different aspects of VT treatment that could be significant for future favorable clinical applications.

Keywords: Ventricular tachycardia; Catheter ablation; Epicardial; Sudden cardiac death; Novel techniques; Substrate

Core tip: Antiarrhythmic drug therapy and endocardial catheter ablation remains the cornerstone of ventricular tachycardia (VT) treatment management, but both treatments have limited efficacy and important adverse effects. Catheter ablation for cardiomyopathic (scar-related) VT is associated with recurrence rates as high as 50% at 6 mo. Implantable cardioverter defibrillator provides a safety net; however, there is an increased need for more effective and safer methods to decrease VT recurrence episodes. We sought to review current literature in order to summarize data on innovative techniques for VT treatment.