2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias Edmond M. Cronin, MB, BCh, BAO, FHRS, CCDS, CEPS-A (Chair),1 Frank M. Bogun, MD (Vice-Chair),2 Philippe Maury, MD (EHRA Chair),3 Petr Peichl, MD, PhD (EHRA Vice-Chair),4 Minglong Chen, MD, PhD, FHRS (APHRS Chair),5 Narayanan Namboodiri, MBBS, MD (APHRS Vice-Chair),6 Luis Aguinaga, MD, PhD, FESC, FACC (LAHRS Chair),7 Luiz Roberto Leite, MD, PhD, FHRS (LAHRS Vice-Chair),8 Sana M. Al-Khatib, MD, MHS, FHRS, CCDS,9 Elad Anter, MD,10 Antonio Berruezo, MD, PhD,11,* David J. Callans, MD, FHRS, CCDS,12 Mina K. Chung, MD, FHRS,13,† Phillip Cuculich, MD,14 Andre d’Avila, MD, PhD,15,‡ Barbara J. Deal, MD, FACC,16,x Paolo Della Bella, MD,17,* Thomas Deneke, MD, PhD, FHRS,18,* Timm-Michael Dickfeld, MD, PhD, FACC, FHRS,19 Claudio Hadid, MD,20,{ Haris M. Haqqani, MBBS, PhD, FHRS,21,# G. Neal Kay, MD, CCDS,22 Rakesh Latchamsetty, MD, FHRS,2 Francis Marchlinski, MD, FHRS,12 John M. Miller, MD, FHRS,23,† Akihiko Nogami, MD, PhD,24,** Akash R. Patel, MD, FHRS, CEPS-P,25,†† Rajeev Kumar Pathak, MBBS, PhD, FHRS,26,# Luis C. Saenz Morales, MD,27,{ Pasquale Santangeli, MD, PhD,12 John L. Sapp, Jr., MD, FHRS,28 Andrea Sarkozy, MD, PhD, FEHRA,29,* Kyoko Soejima, MD,30,# William G. Stevenson, MD, FHRS,31 Usha B. Tedrow, MD, MS, FHRS,32 Wendy S. Tzou, MD, FHRS,33 Niraj Varma, MD, PhD,13 Katja Zeppenfeld, MD, PhD, FESC, FEHRA34,* Document Reviewers: Samuel J. Asirvatham, MD, FHRS; Eduardo Back Sternick, MD, PhD; Janice Chyou, MD; Sabine Ernst, MD, PhD; Guilherme Fenelon, MD, PhD; Edward P. Gerstenfeld, MD, MS, FACC; Gerhard Hindricks, MD; Koichi Inoue, MD, PhD; Jeffrey J. Kim, MD; Kousik Krishnan, MD, FHRS, FACC; Karl-Heinz Kuck, MD, FHRS; Martin Ortiz Avalos, MD; Thomas Paul, MD, FACC, FHRS; Mauricio I. Scanavacca, MD, PhD; Roderick Tung, MD, FHRS; Jamie Voss, MBChB; Takumi Yamada, MD; Teiichi Yamane, MD, PhD, FHRS From the 1Hartford Hospital, Hartford, Connecticut, 2University of Michigan, Ann Arbor, Michigan, 3University Hospital Rangueil, Toulouse, France, 4Institute for Clinical and Experimental Medicine, Prague, Czech Republic, 5Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China, 6Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India, 7Centro Privado de Cardiología, Tucuman, Argentina, 8Instituto Brasília de Arritmia, Brasília, Brazil, 9Duke University Medical Center, Durham, North Carolina, 10Beth Israel Deaconess Medical Center, Boston, Massachusetts, 11Heart Institute, Teknon Medical Center, Barcelona, Spain, 12University of Pennsylvania, Philadelphia, Pennsylvania, 13Cleveland Clinic, Cleveland, Ohio, 14Washington University School of Medicine, St. Louis, Missouri, 15Hospital Cardiologico SOS Cardio, Florianopolis, Brazil, 16Northwestern University Feinberg School of Medicine, Chicago, Illinois, 17Ospedale San Raffaele, Milan, Italy, 18Herz- und Gefaß-Klinik,€ Bad Neustadt, Germany, 19University of Maryland, Baltimore, Maryland, 20Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina, 21University of Queensland, The Prince Charles Hospital, 1547-5271/$-see front matter © 2019 The Heart Rhythm Society; the European Heart Rhythm https://doi.org/10.1016/j.hrthm.2019.03.002 Association, a registered branch of the European Society of Cardiology; the Asia Pacific Heart Rhythm Society; and the Latin American Heart Rhythm Society Published by Elsevier Inc./Oxford University Press/ Wiley. This article is published under the Creative Commons CC-BY license. PGL 5.5.0 DTD HRTHM7935_proof 7 May 2019 6:26 pm ce e2 Heart Rhythm, Vol -,No-, - 2019 Chermside, Australia, 22University of Alabama at Birmingham, Birmingham, Alabama, 23Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana, 24University of Tsukuba, Ibaraki, Japan, 25University of California San Francisco Benioff Children’s Hospital, San Francisco, California, 26Australian National University, Canberra Hospital, Canberra, Australia, 27CardioInfantil Foundation, Cardiac Institute, Bogota, Columbia, 28Queen Elizabeth II Health Sciences Centre, Halifax, Canada, 29University Hospital Antwerp, University of Antwerp, Antwerp, Belgium, 30Kyorin University School of Medicine, Tokyo, Japan, 31Vanderbilt University Heart and Vascular Center, Nashville, Tennessee, 32Brigham and Women’s Hospital, Boston, Massachusetts, 33University of Colorado Denver, Aurora, Colorado, and 34Leiden University Medical Center, Leiden, the Netherlands. *Representative of the European Heart Rhythm Association (EHRA) †Representative of the American College of Cardiology (ACC) ‡Representative of the Sociedade Brasileira de Arritmias Cardíacas (SOBRAC) xRepresentative of the American Heart Association (AHA) {Representative of the Latin American Heart Rhythm Society (LAHRS) #Representative of the Asia Pacific Heart Rhythm Society (APHRS) **Representative of the Japanese Heart Rhythm Society (JHRS) ††Representative of the Pediatric and Congenital Electrophysiology Society (PACES) KEYWORDS Catheter ablation; Clinical document; Electrical storm; resonance imaging; NCSV 5 noncoronary sinus of Valsalva; Electroanatomical mapping; Electrocardiogram; Expert consensus state- NICM 5 nonischemic cardiomyopathy; NIPS 5 noninvasive pro- ment; Imaging; Premature ventricular complex; Radiofrequency ablation; grammed stimulation; NYHA 5 New York Heart Association; Ventricular arrhythmia; Ventricular tachycardia OR 5 odds ratio; OT 5 outflow tract; PES 5 programmed electrical ABBREVIATIONS AAD 5 antiarrhythmic drug; ACT 5 activated stimulation; PET 5 positron emission tomography; clotting time; AF 5 atrial fibrillation; AHD 5 acute hemodynamic pLVAD 5 percutaneous left ventricular assist device; decompensation; AI 5 anatomical isthmus; AIV 5 anterior inter- PPI 5 postpacing interval; PVC 5 premature ventricular complex; ventricular vein; AMC 5 aortomitral continuity; ANS 5 autonomic RBB 5 right bundle branch; RBBB 5 right bundle branch block; nervous system; ARVC 5 arrhythmogenic right ventricular cardio- RCT 5 randomized controlled trial; RF 5 radiofrequency; myopathy; ATP 5 antitachycardia pacing; AV 5 atrioventricular; RSV 5 right sinus of Valsalva; RV 5 right ventricle; RVOT 5 right BBR 5 bundle branch reentry; BBRVT 5 bundle branch reentrant ventricular outflow tract; RWI 5 relationship with industry and ventricular tachycardia; cAMP 5 cyclic adenosine monophos- other entities; SD 5 standard deviation; SHD 5 structural heart phate; CCM 5 Chagas cardiomyopathy; CHD 5 congenital heart disease; SHFM 5 Seattle Heart Failure Model; SOO 5 site of origin; disease; ChD 5 Chagas disease; CIED 5 cardiovascular implant- SPECT 5 single-photon emission computerized tomography; able electronic device; CL 5 cycle length; CMR 5 cardiac magnetic SV 5 sinus of Valsalva; SVT 5 supraventricular tachycardia; resonance imaging; COR 5 class of recommendation; CRT 5 3D 5 three-dimensional; VA 5 ventricular arrhythmia; cardiac resynchronization therapy; CS 5 coronary sinus; VAD 5 ventricular assist device; VF 5 ventricular fibrillation; CSD 5 cardiac sympathetic denervation; CT 5 computed tomogra- VSD 5 ventricular septal defect; VT 5 ventricular tachycardia phy; DCM 5 dilated cardiomyopathy; D-TGA 5 d-transposition of (Heart Rhythm 2019;-:e1–e153) the great arteries; EAM 5 electroanatomical mapping; ECG 5 electrocardiogram; ECGI 5 electrocardiographic imaging; 5 5 5 Developed in partnership with and endorsed by the European Heart Rhythm EF ejection fraction; GCV great cardiac vein; HCM hypertro- fi 5 5 Association (EHRA), the Asia Paci c Heart Rhythm Society (APHRS), and the phic cardiomyopathy; HR hazard ratio; HS hemodynamic sup- Latin American Heart Rhythm Society (LAHRS). Developed in collaboration 5 5 port; IABP intra-aortic balloon pump; ICD implantable with and endorsed by the American College of Cardiology (ACC), the American cardioverter defibrillator; ICE 5 intracardiac echocardiography; Heart Association (AHA), the Japanese Heart Rhythm Society (JHRS), the ICM 5 ischemic cardiomyopathy; IHD 5 ischemic heart disease; Pediatric and Congenital Electrophysiology Society (PACES), and the Socie- LAF 5 left anterior fascicle; LAVA 5 local abnormal ventricular ac- dade Brasileira de Arritmias Cardíacas (SOBRAC). Endorsed by the Canadian tivity; LBB 5 left bundle branch; LBBB 5 left bundle branch block; Heart Rhythm Society. For copies of this document, please contact the Elsevier LGE 5 late gadolinium enhancement; LMNA 5 lamin A/C; Inc. Reprint Department ([email protected]). Permissions: Multiple copies, fi LOE 5 level of evidence; LP 5 late potential; LPF 5 left posterior modi cation, alteration, enhancement, and/or distribution of this document are fascicle; LSV 5 left sinus of Valsalva; LV 5 left ventricle; not permitted without the express permission of the Heart Rhythm Society. Instructions for obtaining permission are located at https://www.elsevier.com/ LVAD 5 left ventricular assist device; LVEF 5 left ventricular ejec- 5 5 about/our-business/policies/copyright/permissions. This article has been tion fraction; LVNC left ventricular noncompaction; LVOT left copublished in Europace and the Journal of Arrhythmia. Correspondence: Heart fl 5 ventricular out ow tract; MDCT multidetector cardiac computed Rhythm Society, 1325 G Street NW, Suite 400, Washington, DC 20005. E-mail tomography; MI 5 myocardial infarction; MRI 5 magnetic address: [email protected]. PGL 5.5.0 DTD HRTHM7935_proof 7 May 2019 6:26 pm ce Cronin