Epicardial radiofrequency ablation safely and effectively treated ventricular tachycardia in patients with Chagas' disease, whereas epicardial mapping did not enhance endocardial ablation efficacy.
Observational (n=10)
Does epicardial mapping and ablation improve outcomes in patients with recurrent ventricular tachycardia and Chagas' disease?
Epicardial applications of RF energy guided by epicardial mapping can safely and effectively treat recurrent VT in patients with Chagas' disease, whereas epicardial mapping does not enhance the effectiveness of endocardial RF pulses.
p-value: p=0.004
INTRODUCTION: An epicardial site of origin of ventricular tachycardia (VT) may explain unsuccessful endocardial radiofrequency (RF) catheter ablation. A new technique to map the epicardial surface of the heart through pericardial puncture was presented recently and opened the possibility of using epicardial mapping to guide endocardial ablation or epicardial catheter ablation. We report the efficacy and safety of these two approaches to treat 10 consecutive patients with VT and Chagas' disease. METHODS AND RESULTS: Epicardial mapping was carried out with a regular steerable catheter introduced into the pericardial space. An epicardial circuit was found in 14 of 18 mapable VTs induced in 10 patients. Epicardial mapping was used to guide endocardial ablation in 4 patients and epicardial ablation in 6. The epicardial earliest activation site occurred 107+/-60 msec earlier than the onset of the QRS complex. At the epicardial site used to guide endocardial ablation, earliest activation occurred 75+/-55 msec before the QRS complex. Epicardial mid-diastolic potentials and/or continuous electrical activity were seen in 7 patients. After 4.8+/-2.9 seconds of epicardial RF applications, VT was rendered noninducible. Hemopericardium requiring drainage occurred in 1 patient; 3 others developed pericardial friction without hemopericardium. Patients remain asymptomatic 5 to 9 months after the procedure. Interruption during endocardial pulses occurred after 20.2+/-14 seconds (P = 0.004), but VT was always reinducible and the patients experienced a poor outcome. CONCLUSION: Epicardial mapping does not enhance the effectiveness of endocardial pulses of RF. Epicardial applications of RF energy can safely and effectively treat patients with VT and Chagas' disease.
Sosa et al. (1998) conducted an observational in Ventricular tachycardia and Chagas' disease (n=10). Epicardial mapping-guided epicardial or endocardial radiofrequency ablation was evaluated on Efficacy (VT noninducibility) and safety (p=0.004). Epicardial radiofrequency ablation safely and effectively treated ventricular tachycardia in patients with Chagas' disease, whereas epicardial mapping did not enhance endocardial ablation efficacy.