Key result
Hybrid surgical epicardial VT cryoablation via median sternotomy successfully treated VT storm, with the patient remaining arrhythmia-free for 30 months without antiarrhythmic therapy.
Why the study?
Epicardial ablation is often required for scar-related VT in non-ischaemic cardiomyopathy, but percutaneous subxiphoid access is not feasible in up to 28% of cases.
Case Report (n=1)
No
Hybrid surgical epicardial cryoablation via median sternotomy in the EP laboratory is a feasible and safe alternative for refractory VT when percutaneous access fails.
Alternative epicardial access may succeed when subxiphoid fails in scar-related VT; leaves open need for validation before wider use.
Background: Scar-related ventricular tachycardia (VT) is a challenging medical condition, with catheter ablation providing a valuable treatment option. Whilst most VTs can be ablated endocardially, epicardial ablation is often required in patients with non-ischaemic cardiomyopathy. The percutaneous subxiphoid technique has become instrumental for epicardial access. However, it is not feasible in up to 28% of cases for multiple reasons. Case summary: A 47-year-old patient was managed at our centre for VT storm and recurrent implantable cardioverter defibrillator shocks for monomorphic VT despite maximum drug therapy. No scar was noted during endocardial mapping, with confirmation of the localized epicardial scar on cardiac magnetic resonance imaging (CMR). Following failed percutaneous epicardial access, a successful hybrid surgical epicardial VT cryoablation via median sternotomy was performed in the electrophysiology (EP) laboratory utilizing data from CMR, prior endocardial ablation, and conventional EP mapping. The patient has remained arrhythmia-free for 30 months post-ablation without antiarrhythmic therapy. Discussion: This case describes a practical multidisciplinary approach to managing a challenging clinical problem. Whilst the described technique is not entirely novel, this is the first case report that describes the practicalities and demonstrates the safety and feasibility of hybrid epicardial cryoablation via median sternotomy performed in the cardiac EP laboratory for the sole treatment of VT.
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Jathanna et al. (2023) conducted a case report in Ventricular tachycardia storm (n=1). Hybrid surgical epicardial VT cryoablation via median sternotomy was evaluated on Arrhythmia-free survival. Hybrid surgical epicardial VT cryoablation via median sternotomy successfully treated VT storm, with the patient remaining arrhythmia-free for 30 months without antiarrhythmic therapy.
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