Key result
Open chest ECC-supported hybrid epicardial ablation achieved acute procedural success in 100% of high-risk patients with previously failed percutaneous ablations, with 80% VT-free at 6 months.
Why the study?
Recurrent VT after percutaneous ablation carries high morbidity and mortality, prompting assessment of open chest extracorporeal circulation-supported 3D mapping and ablation after failed percutaneous attempts.
Does open chest ECC-supported targeted VT substrate ablation prevent recurrent VT in high-risk patients with previously failed percutaneous endocardial and epicardial VT ablations?
Observational (n=5)
Does open chest ECC-supported targeted VT substrate ablation prevent recurrent VT in high-risk patients with previously failed percutaneous endocardial and epicardial VT ablations?
Open chest ECC-supported hybrid VT ablation is feasible and can successfully abolish VT substrate in high-risk patients with previously failed percutaneous ablations, though it carries significant surgical risks.
May warrant consideration as rescue therapy in refractory VT but with substantial surgical risks; hypothesis-generating and requires prospective validation.
INTRODUCTION: Recurrent ventricular tachycardia (VT) after percutaneous ablation is associated with a high morbidity and mortality. We assessed the feasibility of open chest extracorporeal circulation (ECC)-supported 3D multielectrode mapping and targeted VT substrate ablation in patients with previously failed percutaneous endocardial and epicardial VT ablations. METHODS: In patients with previously failed percutaneous endocardial and epicardial VT ablations and a high risk of hemodynamic collapse during the procedure, open chest ECC-supported mapping and ablation were performed in a hybrid EP lab setting. Electro-anatomic maps (3D) were acquired during sinus rhythm and VT using a multielectrode mapping catheter (HD grid; Abbott or Pentaray, Biosense Webster). Irrigated radiofrequency ablations of all inducible VT were performed with a contact force ablation catheter. RESULTS: Hybrid VT ablation was performed in 5 patients with structural heart disease (i.e., 3 with previous old myocardial infarction and 2 with nonischemic cardiomy-opathy) and recurrent VT. Acute procedural success was achieved in all patients. Four patients were successfully weaned off the ECC. In 1 patient with a severely reduced LVEF (16%), damage to the venous graft occurred after sternotomy and that patient died after 1 month. Four patients (80%) remained VT free after a median follow-up of 6 (IQR 4-10) months. CONCLUSION: In high-risk patients with previously failed percutaneous endocardial and epicardial VT ablations, open chest ECC-supported multielectrode epicardial mapping revealed a VT substrate in all of the patients, and targeted epicardial ablation abolished VT substrate in these patients.
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Haanschoten et al. (2019) conducted an observational in Recurrent ventricular tachycardia (n=5). Open chest ECC-supported hybrid VT ablation was evaluated on Acute procedural success. Open chest ECC-supported hybrid epicardial ablation achieved acute procedural success in 100% of high-risk patients with previously failed percutaneous ablations, with 80% VT-free at 6 months.
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