Pathogenesis of Ventricular Tachyarrhythmias

• Volume 120 • Number 4 www.anesthesia-analgesia.org 737 Copyright © 2015 International Anesthesia Research Society DOI: 10.1213/ANE.0000000000000556 During the past few decades, cardiac electrophysiology (EP) has evolved from a specialty that primarily implanted simple pulse generators (pacemakers) for bradycardia therapy to a specialty with an expanded practice in detecting and terminating arrhythmogenicity via complex catheter-based techniques. Representative of this development are the rapidly evolving treatment options for patients with ventricular tachycardia and fibrillation (VT/VF), the most common cause of sudden cardiac death. Pharmacotherapy has not proven to be an adequate treatment option for many of these patients. Although implantable cardioverter defibrillators (ICDs) are effective in terminating VT/VF, repetitive shocks significantly impair quality of life, and inappropriate ICD shocks in patients with heart failure are associated with increased mortality.1 Percutaneous catheter ablation has evolved as a promising therapy, particularly in patients with recurrent hemodynamically unstable VT refractory to drugs. Developed in the 1970s to guide surgical ablation,2–4 the first percutaneous catheter VT ablation was reported in 1983 in a patient with focal VT originating in the right ventricular outflow tract.5 Since then, the field of VT catheter ablation has seen tremendous growth, partially due to an increase in survival of patients with heart failure and structural heart disease. This review provides a comprehensive update on currently performed VT ablation procedures and their anesthetic considerations.