Epicardial Ablation for Ventricular Tachycardia

BACKGROUND: The purpose of this study was to describe the epicardial percutaneous ablation experience of 6 European high-volume ventricular tachycardia (VT) ablation centers. METHODS AND RESULTS: Data from 218 patients with coronary artery disease (CAD, n=85 39.0%), idiopathic dilated of patients with idiopathic VT cardiomyopathy (IDCM, n=67 30.7%), arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARCD/C, n=13 6%), hypertrophic cardiomyopathy (HCM, n=5 2.3%), and absence of structural heart disease (n=48 22%) undergoing epicardial subxyphoid access for VT ablation were collected. The epicardial approach was attempted as first-line treatment in 78 patients (35.8%). Acute prevention of VT inducibility was obtained in 156 patients (71.6%). There were no procedure-related deaths. Cardiac tamponade occurred in 8 patients, and abdominal hemorrhage in 1 patient. Six patients died of electrical storm recurrence within 48 hours from the procedure. After a mean follow-up of 17.3±18.2 months, 60 patients (31.4%) presented with VT recurrence (39.3% of IDCM patients; 34.7% of CAD patients; 30.8% of ARVD/C patients; 25% of HCM patients; 17.1% of patients with idiopathic VT). Twenty patients (10.4%) died during follow-up (12 of heart failure, 2 of cardiac arrest, and 6 of extracardiac causes). CONCLUSIONS: In experienced centers, epicardial ablation of VT has an acceptable risk and favorable outcome. In selected patients, it is reasonable to consider as a first-line ablation approach.