Therapiedoelen voor percutane behandeling van ventriculaire aritmieën

The field of clinical cardiac electrophysiology has seen a phenomenal expansion of therapeutic possibilities over a span of a few decades. Largely this expansion has been propelled by mechanistic understanding of disease, coupled to technology advances in mapping and ablation. In this thesis, we study some of the aspects through which clinical practice and technological innovation interact and how these interactions impact clinical outcomes. First, we study a very specific application of mapping technology used for the localization of premature ventricular beats as ablation targets, and evaluate the presence of a positioning error which exists due to the nature of these mapping systems. In addition, we describe a practical approach to observing and correcting for this error with the goal of improving ablation efficacy. Furthermore, we study the safety and feasibility of novel ablation technology called ultralow temperature cryoablation (ULTC), which uses liquid nitrogen as a powerful coolant, for the treatment of atrial fibrillation and ventricular tachycardia. Due to the potential benefits of cryoablation over radiofrequency (RF) ablation in the setting of abnormal tissue such as scar or synthetic patches, we hypothesize a benefit of ULTC might exist when trying to achieve lesion formation in tissue located below a surgical patch. This hypothesis is tested in an in vitro setting with a synthetic patch covering the target tissue, aiming to quantify the relative reduction in efficacy between ULTC and RF ablation. Finally, we review monitoring tools applicable to all types of VT ablation but with a particular focus on hemodynamic monitoring during mechanical support of ventricular output for the purpose of studying ongoing VT without compromising patient safety.