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


DeepDyve research library

PubMed Articles [3751 Associated PubMed Articles listed on BioPortfolio]

Outcomes of catheter ablation of ventricular tachycardia with mechanical hemodynamic support: An analysis of the Medicare database.

There is a paucity of data in favor of mechanical support during catheter ablation of ventricular tachycardia (VT). This study investigated the outcomes of VT ablation associated with mechanical suppo...

Efficacy of an Anatomical Approach in Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating From the Left Ventricular Outflow Tract.

When anatomic obstacles preclude radiofrequency catheter ablation of idiopathic ventricular arrhythmias (VAs) originating from the left ventricular outflow tract (LVOT), an alternative approach from t...

Aneurysm-related ischemic ventricular tachycardia: safety and efficacy of catheter ablation.

Left ventricular aneurysm (LVA) postmyocardial infarction (MI) might be an arrhythmogenic substrate. We examined the safety and efficacy of catheter ablation of LVA-related ventricular tachycardia (VT...

Prediction and prognosis of ventricular tachycardia recurrence after catheter ablation with remote magnetic navigation for electrical storm in patients with ischemic cardiomyopathy.

Ventricular tachycardia (VT) recurrence after catheter ablation for electrical storm is commonly seen in patients with ischemic cardiomyopathy (ICM).

The effect of radiofrequency catheter ablation of frequent premature ventricular complexes and arrhythmia burden on left ventricular function.

Frequent premature ventricular complexes (PVC) are related to reversible tachycardia-induced cardiomyopathy. However, the role of arrhythmia burden on the outcome of the catheter ablation has not been...

Clinical Trials [3346 Associated Clinical Trials listed on BioPortfolio]

Intramural Needle Ablation for Ablation of Recurrent Ventricular Tachycardia

The purpose of the study is to assess the effectiveness and safety of a new device called an Intramural Needle Ablation Catheter (INA catheter). The INA catheter is used for locating and ...

Substrate Targeted Ablation Using the FlexAbility™ Ablation Catheter System for the Reduction of Ventricular Tachycardia

To demonstrate that scar-based ventricular tachycardia (VT) ablation using the FlexAbility™ ablation catheter system results in a superior clinical outcome compared to routine drug thera...

Preventive aBlation of vEntricular tachycaRdia in Patients With myocardiaL INfarction

The BERLIN VT study is designed to evaluate the impact of prophylactic ventricular tachycardia (VT) ablation on all-cause mortality and unplanned hospital admission for congestive heart fa...

Catheter Evaluation for Endocardial Ablation in Patients With Ventricular Tachycardia

The primary objective is to provide additional corroborative safety and efficacy data for the Navistar ThermoCool catheter for the treatment of subjects with ischemic Ventricular Tachycard...

Hybrid Catheter Ablation for Persistent Atrial Fibrillation

prospective randomized controlled trial In repeat procedure for persistent atrial fibrillation, Hybrid group (Epicardial ablation + Endocardial ablation) versus control group (conventiona...

Medical and Biotech [MESH] Definitions

Removal of tissue by vaporization, abrasion, or destruction. Methods used include heating tissue by hot liquids or microwave thermal heating, freezing (CRYOABLATION), chemical ablation, and photoablation with LASERS.

Removal of tissue with electrical current delivered via electrodes positioned at the distal end of a catheter. Energy sources are commonly direct current (DC-shock) or alternating current at radiofrequencies (usually 750 kHz). The technique is used most often to ablate the AV junction and/or accessory pathways in order to interrupt AV conduction and produce AV block in the treatment of various tachyarrhythmias.

Implantable devices which continuously monitor the electrical activity of the heart and automatically detect and terminate ventricular tachycardia (TACHYCARDIA, VENTRICULAR) and VENTRICULAR FIBRILLATION. They consist of an impulse generator, batteries, and electrodes.

An abnormally rapid ventricular rhythm usually in excess of 150 beats per minute. It is generated within the ventricle below the BUNDLE OF HIS, either as autonomic impulse formation or reentrant impulse conduction. Depending on the etiology, onset of ventricular tachycardia can be paroxysmal (sudden) or nonparoxysmal, its wide QRS complexes can be uniform or polymorphic, and the ventricular beating may be independent of the atrial beating (AV dissociation).

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.

Quick Search

DeepDyve research library

Relevant Topics

Hepatology is the study of liver, gallbladder, biliary tree, and pancreas, and diseases associated with them. This includes viral hepatitis, alcohol damage, cirrhosis and cancer. As modern lifestyles change, with alcoholism and cancer becoming more promi...

Cardiology is a specialty of internal medicine.  Cardiac electrophysiology : Study of the electrical properties and conduction diseases of the heart. Echocardiography : The use of ultrasound to study the mechanical function/physics of the h...

Searches Linking to this Article