Key result
Epicardial ventricular tachycardia ablation is reviewed as a treatment strategy for patients with an epicardial substrate, either after failed endocardial ablation or as first-line therapy.
This review discusses the evidence for identifying ventricular tachycardia of epicardial origin and selecting patients who would benefit from an epicardial ablation approach.
May support epicardial VT ablation in select patients with epicardial substrate; leaves open optimal first-line use pending randomized trials.
With the widespread use of implantable cardioverter-defibrillators, an increasing number of patients present with ventricular tachycardia (VT). Large multicentre studies have shown that ablation of VT successfully reduces recurrent VT and this procedure is being performed by an increasing number of centres. However, for a number of reasons, many patients experience VT recurrence after ablation. One important reason for VT recurrence is the presence of an epicardial substrate involved in the VT circuit which is not affected by endocardial ablation. Epicardial access and ablation is now frequently performed either after failed endocardial VT ablation or as first-line treatment in selected patients. This review will focus on the available evidence for identifying VT of epicardial origin, and discuss in which patients an epicardial approach would be benefitial.
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Roten et al. (2012) conducted a review in Ventricular tachycardia. Epicardial ventricular tachycardia ablation was evaluated. Epicardial ventricular tachycardia ablation is reviewed as a treatment strategy for patients with an epicardial substrate, either after failed endocardial ablation or as first-line therapy.
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