Percutaneous epicardial ablation was successful in 28.5% of patients with accessory pathways refractory to conventional ablation, serving as an alternative when other approaches fail.
Observational (n=21)
Percutaneous epicardial mapping and ablation is a viable alternative for accessory pathways refractory to conventional endocardial or transvenous epicardial ablation.
BACKGROUND: Epicardial mapping and ablation of accessory pathways through a subxiphoid approach can be an alternative when endocardial or epicardial transvenous mapping has failed. METHODS AND RESULTS: We reviewed acute and long-term follow-up of 21 patients (14 males) referred for percutaneous epicardial accessory pathway ablation. There was a median of 2 previous failed procedures. All patients were highly symptomatic, 8 had atrial fibrillation (3 with cardiac arrest) and 13 had frequent symptomatic episodes of atrioventricular reentrant tachycardia. Six patients (28.5%) had a successful epicardial ablation. Five patients (23.8%) underwent a successful repeated endocardial mapping, and ablation after epicardial mapping yielded no early activation site. Epicardial mapping was helpful in guiding endocardial ablation in 2 patients (9.5%), showing that the earliest activation was simultaneous at the epicardium and endocardium. Four patients (19%) underwent successful open-chest surgery after failing epicardial/endocardial ablation. Two patients (9.5%) remained controlled under antiarrhythmic drugs after unsuccessful endocardial/epicardial ablation. Two patients had a coronary sinus diverticulum and one a right atrium to right ventricle diverticulum. Three patients acquired postablation coronary sinus stenosis. There was no major complication related to pericardial access. CONCLUSIONS: Percutaneous epicardial approach is an alternative when conventional endocardial or transvenous epicardial ablation fails in the elimination of the accessory pathway. A new attempt by endocardial approach was successful in a significant number of patients. Open-chest surgery may be required in symptomatic cases refractory to endocardial-epicardial approach.
Scanavacca et al. (Mon,) conducted a observational in Accessory atrioventricular pathways refractory to catheter ablation (n=21). Percutaneous epicardial accessory pathway ablation was evaluated on Successful epicardial ablation. Percutaneous epicardial ablation was successful in 28.5% of patients with accessory pathways refractory to conventional ablation, serving as an alternative when other approaches fail.