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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.
This article was published in the following journal.
Name: Heart rhythm : the official journal of the Heart Rhythm Society
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