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Apport de l’électro-imagerie en électrophysiologie cardiaque pour la prise en charge des troubles du rythme ventriculaire graves

Abstract : Ventricular arrhythmia remains a major public health problem, in particular ventricular tachycardias. These arrhythmias most often occur in patients who previously presented a myocardial infarction. Radiofrequency ablations represent the most effective treatment to suppress these tachycardias. However, the short- and long-term results are still imperfect, paving the way for improvements.We detail in this manuscript the physiopathological principles of occurrence of these ventricular tachycardias, the operating principles of the diagnostic tools used for their mapping, as well as the principles of destruction of the circuits of these arrhythmias. We review the contribution of imaging for the characterization of myocardial tissues and the identification of circuits. We present the specificities of the pace-mapping technique developed at the University Hospital of Nancy and which makes it possible to produce ventricular tachycardia maps in situations where the usual activation maps are not possible. This technique could also be considered for the analysis of the efficiency of the ablation lesions performed.We also present the current state of knowledge to determine the risk of an asymptomatic patient of developing ventricular tachycardia in the future. Risk stratification is currently based on left ventricular ejection fraction, but the growing importance of imaging, especially MRI, opens the way in the short term to individual risk determination. We present here our contribution to the improvement of the MRI tool and to the work of analyzing infarct scars to predict the risk of arrhythmias. Improvements in the prediction of individual risk are an essential step in the development of personalized medicine
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Submitted on : Tuesday, May 10, 2022 - 11:58:41 AM
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  • HAL Id : tel-03663604, version 1

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Jean-Marc Sellal. Apport de l’électro-imagerie en électrophysiologie cardiaque pour la prise en charge des troubles du rythme ventriculaire graves. Ingénierie biomédicale. Université de Lorraine, 2021. Français. ⟨NNT : 2021LORR0241⟩. ⟨tel-03663604⟩

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