Ventricular arrhythmias

Based on many years of experience in surgical mapping and ablation of ventricular tachycardia, the staff have developed innovative strategies to

• identify the electrically "diseased" areas responsible for ventricular arrhythmias;
• isolate these areas to interrupt the tachycardia;
• prevent new arrhythmia attacks by removing areas at risk of new arrhythmias.

Complex arrhythmias, such as ventricular tachycardias, often cannot be resolved by traditional ablation, i.e. "from inside" the heart cavities, as the inducing circuits cross the muscle wall and are located on the "outside" surface of the heart (epicardium). The evolution of electrophysiological techniques has recently led to the development of a technique - pericardiocentesis - assuring access to the epicardium. Our team performs daily epicardial mapping and ablation procedures to treat ventricular tachycardias and arrhythmias that cannot be controlled by traditional ablation, thus implementing the most innovative treatment approach available today.

Advanced treatment of ventricular tachycardia

In some patients, ventricular tachycardia may require early intervention and intensive care. The procedural model for improved management of the ventricular tachycardia patient is based on a 24-hour telephone number: the patient is admitted and undergoes arrhythmic and clinical risk stratification at the first assessment. By analysing haemodynamic and arrhythmic status, the patient is classified as high, medium or low risk. The case is then discussed with the cardiac surgeon and anaesthetist/resuscitator, and a joint decision is made on referral to hospital, the need and type of haemodynamic stabilisation (enhanced external counterpulsation may be provided), the need for cerebral circulation protection techniques (cerebral oximetry), the pre-procedural diagnostic approach and ablation priority (emergency, after clinical stabilisation or elective).

The Arrhythmology and Cardiac Electrophysiology Department is equipped with eight beds for dedicated treatment of such patients:

• arrhythmological care, available 24hrs;
• continuous telemetric monitoring with 12-lead ECG;
• invasive blood pressure monitoring;
• specialised outpatient follow-up clinic;
• trained nursing staff.

Before discharge, patients are referred to an outpatient follow-up clinic, an option operating in parallel and in cooperation with the referring outpatient cardiologist. The criticality of these patients, who are often susceptible to even severe heart failure, is also supported by interaction with the outpatient heart failure clinic, where cases are discussed collegially with cardiologists, anaesthetists-resuscitators and cardiac surgeons for early identification of the need for surgical treatment of decompensation (VAD implantation, heart transplantation).

Thus, this model provides the patient with a pre-assessment and comprehensive intra-, peri- and post-procedural support through a multidisciplinary criterion that guarantees the most specific expertise with regard to the multiple aspects that characterise such complex diseases.