Epicardial Ablation of Ventricular Tachycardia
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Key result
Epicardial mapping and ablation via a percutaneous subxiphoid technique is an essential adjunctive strategy for treating complex ventricular tachycardia when endocardial ablation alone is insufficient.
Why the study?
Does adjunctive epicardial ablation reduce recurrent ventricular tachycardia in patients with cardiomyopathy compared to endocardial ablation alone?
Population
Patients with recurrent ventricular tachycardia and complex myocardial scars due to ischemic cardiomyopathy…
Comparison
Epicardial mapping and ablation via a… vs Endocardial ablation alone.
Design
Review
Authors
Discussion
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Implication
May support epicardial access in refractory VT after failed endocardial ablation; leaves open need for randomized trials to confirm benefit.
Structured PICO
Does adjunctive epicardial ablation reduce recurrent ventricular tachycardia in patients with cardiomyopathy compared to endocardial ablation alone?
P
Population
Patients with recurrent ventricular tachycardia and complex myocardial scars due to ischemic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, hypertrophic cardiomyopathy, or Chagas disease.
I
Intervention
Epicardial mapping and ablation via a percutaneous subxiphoid technique (often as an adjunct to endocardial ablation).
C
Comparator
Endocardial ablation alone.
O
Outcome
Freedom from recurrent ventricular tachycardia.
Epicardial ablation is an essential adjunctive strategy for treating recurrent ventricular tachycardia in patients with complex myocardial scars when endocardial ablation alone is insufficient.
Limitations
- Risk of collateral damage to coronary arteries and the phrenic nerve during ablation.
- Epicardial fat can insulate the myocardium, making it difficult to distinguish from scar and impairing the efficacy of radiofrequency delivery.
- Potential for procedural complications including symptomatic pericarditis and hemopericardium.
Cite This Study
Tung et al. (2015) conducted a review in Ventricular Tachycardia. Epicardial mapping and ablation vs. Endocardial ablation alone was evaluated. Epicardial mapping and ablation via a percutaneous subxiphoid technique is an essential adjunctive strategy for treating complex ventricular tachycardia when endocardial ablation alone is insufficient.
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