Epicardial ablation can successfully eliminate VT in peripartum cardiomyopathy with extensive epicardial scar, though long-term mortality risk remains high.
May support epicardial ablation for VT elimination in peripartum cardiomyopathy; leaves open long-term survival impact.
A 38-year-old female with prior failed endocardial ablation for ventricular tachycardia (VT) was referred for further treatment. She had been diagnosed with peripartum cardiomyopathy 7 years before and had persistent left ventricular dysfunction with an ejection fraction of 20%. Epicardial voltage mapping showed extensive epicardial scar despite absence of endocardial scar. Five distinct VT morphologies were induced. Ablation was aided by electrogram characteristics, pace mapping, entrainment mapping, and establishing electrical inexcitability along areas of epicardial scar. After epicardial ablation no sustained VT was induced. She had been doing well without VT occurrence but died 1 year later unexpectedly at home.
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Tokuda et al. (2013) studied this question.
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