Percutaneous epicardial mapping and ablation successfully treated 71% (17/24) of ventricular tachycardias originating from the epicardium in patients with previously failed endocardial ablation.
Observational (n=48)
Does percutaneous subxiphoid epicardial mapping and ablation improve procedural success in patients with previously failed endocardial ablation?
Percutaneous epicardial mapping and ablation is a feasible and safe alternative strategy for patients with arrhythmias, particularly VT, who have failed prior endocardial ablation.
BACKGROUND: The epicardial location of an arrhythmia could be responsible for unsuccessful endocardial catheter ablation. METHODS AND RESULTS: In 48 patients referred after prior unsuccessful endocardial ablation, we considered percutaneous, subxiphoid instrumentation of the pericardial space for mapping and ablation. Thirty patients had ventricular tachycardia (VT), 6 patients had a right- and 4 had a left-sided accessory pathway (AP), 4 patients had inappropriate sinus tachycardia, and 4 patients had atrial arrhythmias. Of the 30 VTs, 24 (6 with ischemic cardiomyopathy, 3 with idiopathic cardiomyopathy, and 15 with normal hearts) appeared to originate from the epicardium. Seventeen (71%) of these 24 VTs were successfully ablated with epicardial lesions. The other 7 VTs had early epicardial sites that were inaccessible, predominantly because of interference from the left atrial appendage. Six of these were successfully ablated from the left coronary cusp. In 5 of the 10 patients with an AP, the earliest activation was recorded epicardially. Three of these were right atrial appendage-to-right ventricle APs, and epicardial ablation was successful. No significant complications were observed. CONCLUSIONS: Failure of endocardial ablation could reflect the presence of an epicardial arrhythmia substrate. Epicardial instrumentation and ablation appeared feasible and safe and provided an alternative strategy for the treatment of patients with a variety of arrhythmias. This was particularly true for VT, including patients without structural heart disease.
Schweikert et al. (2003) conducted an observational in Arrhythmias with prior unsuccessful endocardial ablation (n=48). Percutaneous epicardial mapping and ablation was evaluated on Successful ablation of epicardial ventricular tachycardia. Percutaneous epicardial mapping and ablation successfully treated 71% (17/24) of ventricular tachycardias originating from the epicardium in patients with previously failed endocardial ablation.