Catheter Ablation for Ventricular Tachycardia after failed Endocardial Ablation - Epicardial Substrate or Inappropriate Endocardial Ablation?

Summary of "Catheter Ablation for Ventricular Tachycardia after failed Endocardial Ablation - Epicardial Substrate or Inappropriate Endocardial Ablation?"

BACKGROUND :: The substrate of myocardial VT may involve the subepicardial myocardium.
: We aimed to assess the incidence of epicardial substrates in patients with a previously failed endocardial ablation attempt for ventricular tachycardia (VT) as well as safety and effectiveness of epicardial ablation.
: Using an electroanatomical mapping system, endo- and epicardial maps were acquired. Irrigated radiofrequency current ablations of all inducible VTs were performed.
: Between 2005 and 2009 fifty-nine patients with or without structural heart disease underwent epicardial VT ablation. Pericardial access failed in 3 of these patients (5%). Of the remaining 56 patients, an epicardial substrate was found in 41 (73%). Overall, acute success was achieved in 46/59 patients (78%) with complete VT abolition in 27 (46%) and partial abolition in 19 (32%). Successful outcomes were the result of endocardial ablation only in 14 patients (24%), epicardial ablation in 21 patients (36%) and endo-/epicardial in 11 patients (19%). Ablation failed to prevent reinduction in 8 patients (13%) and VTs were non-inducible prior to ablation in 5 (8%). Two peri-procedural deaths occurred, one after right ventricular perforation and one due to electromechanical dissociation. In two patients, hepatic bleeding was observed. Recurrence of any VT occurred in 27/57 surviving patients (47%) during a median follow-up of 362 days (q1-q3; 180-468 days). Repeat epicardial mapping was not feasible due to adhesions in 3/12 (25%) patients.
: In patients with a previously failed endocardial VT ablation, epicardial mapping reveals a VT substrate in nearly (3/4) of all patients, and epicardial ablation is required for successful VT abolition in more than half of the patients. However, life-threatening complications may occur. Repeat epicardial access was not possible in 25% due to local pericardial adhesions.


Asklepios Klinik St. Georg, Dept. of Cardiology, Hamburg, Germany.

Journal Details

This article was published in the following journal.

Name: Heart rhythm : the official journal of the Heart Rhythm Society
ISSN: 1556-3871


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Medical and Biotech [MESH] Definitions

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A malignant form of polymorphic ventricular tachycardia that is characterized by HEART RATE between 200 and 250 beats per minute, and QRS complexes with changing amplitude and twisting of the points. The term also describes the syndrome of tachycardia with prolonged ventricular repolarization, long QT intervals exceeding 500 milliseconds or BRADYCARDIA. Torsades de pointes may be self-limited or may progress to VENTRICULAR FIBRILLATION.

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