Catheter ablation for ventricular tachycardia after failed endocardial ablation: Epicardial substrate or inappropriate endocardial ablation?

Schmidt, Boris; Chun, K.R. Julian; Baensch, Dietmar; Antz, Matthias; Koektuerk, Buelent; Tilz, Roland Richard; Metzner, Andreas; Ouyang, Feifan; Kück, Karl‐Heinz

doi:10.1016/j.hrthm.2010.08.010

Cited by 119 publications

(85 citation statements)

References 35 publications

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“…14 The yield of epicardial ablation in the postinfarct setting is dependent on prior ablation history, where enriched epicardial substrates may be selected due to referral bias after unsuccessful endocardial ablation. 15,16 …”

Section: Indications For Epicardial Mapping and Ablationmentioning

confidence: 99%

Epicardial Ablation of Ventricular Tachycardia

Tung

Shivkumar

2015

Methodist DeBakey Cardiovascular Journal

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Epicardial mapping and ablation via a percutaneous subxiphoid technique has been instrumental in improving the working understanding of complex myocardial scars in various arrhythmogenic substrates. Endocardial ablation alone may not be sufficient in patients with ischemic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, hypertrophic cardiomyopathy, and Chagas disease to prevent recurrent ventricular tachycardia. Multiple observational studies have demonstrated greater freedom from recurrence with adjunctive epicardial ablation compared with endocardial ablation alone. While epicardial ablation is performed predominantly at tertiary referral centers, knowledge of the technical approach, clinical indications, and potential complications is imperative to maximizing clinical success and patient safety.In 1996, Sosa and colleagues modified the pericardiocentesis technique to enable percutaneous access to the pericardial space for mapping and catheter ablation of ventricular tachycardia.1 Originally developed for patients with epicardial scarring due to chagasic cardiomyopathy and patients with ischemic cardiomyopathy refractory to endocardial ablationm, 2,3 this approach has since become an essential part of the armamentarium for the treatment of ventricular tachycardia. Myocardial scars are three-dimensionally complex with varying degrees of transmurality, and the ability to map and ablate the epicardial surface has contributed to a greater understanding of scar-related VT in postinfarction cardiomyopathy and nonischemic substrates including idiopathic dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, hypertrophic cardiomyopathy, and chagasic cardiomyopathy. In this review, we highlight the percutaneous approach and discuss clinical indications and potential complications.

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Section: Indications For Epicardial Mapping and Ablationmentioning

confidence: 99%

Epicardial Ablation of Ventricular Tachycardia

Tung

Shivkumar

2015

Methodist DeBakey Cardiovascular Journal

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“…Then, if the VT was inducible and hemodynamically unstable, the RF current was applied as soon as any diastolic activity was recorded. If the endocardial mapping and ablation failed, we switched to epicardial mapping and ablation [20].…”

Section: Mapping and Ablationmentioning

confidence: 99%

Long‐term outcomes of catheter ablation of ventricular tachycardia in patients with structural heart disease

Goya

Fukunaga

Hiroshima

et al. 2014

Journal of Arrhythmia

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a b s t r a c tBackground: Catheter ablation of ventricular tachycardia (VT) is feasible. However, the long-term outcomes for different underlying diseases have not been well defined. Methods: Eighty-eight consecutive patients who underwent catheter ablation of VT using a threedimensional mapping system were analyzed. The primary endpoint was any VT or ventricular fibrillation (VF) recurrence. Secondary endpoints were a composite of death or any VT/VF recurrence. Underlying heart diseases were remote myocardial infarction (remote MI) in 51 patients and non-ischemic cardiomyopathy in 37 (arrhythmogenic right ventricular cardiomyopathy [ARVC] in 18 patients, and dilated cardiomyopathy [NIDCM] in 19). Results: Acute success was achieved in 82 of 88 (93%) patients. During a follow-up period of 39.2 74.6 months, VT recurred in 26 of 87 (30%), and VT/VF recurrence or death occurred in 39 of 87 (45%) patients. ARVC had better outcomes than NIDCM for the primary (p o 0.05) and secondary endpoints (po 0.05). Remote MI-VT revealed a midrange outcome. Conclusions: The long-term outcomes after catheter ablation of VT varied according to the underlying heart disease. ARVC-VT ablation was associated with better long-term prognosis than NIDCM. Remote MI-VT demonstrated a midrange outcome.

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“…Schmidt et al reported that 59 patients underwent epicardial VT ablation following an unsuccessful endocardial VT ablation procedure [12]. They gained pericardial access as described by Sosa et al [2] with liver bleeding due to liver puncture occurring in 2 (3%) patients during the perioperative period.…”

Section: The Correlation With Surrounding Organsmentioning

confidence: 99%

Anatomical consideration for safe pericardiocentesis assessed by three‐dimensional computed tomography: Should an anterior or posterior approach be used?

Teranishi

Okajima

Kiuchi

et al. 2014

Journal of Arrhythmia

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a b s t r a c tBackground: The efficacy of epicardial catheter ablation for ventricular tachycardia has been reported. However, the safest anatomical method for pericardial puncture has not been determined. Methods: Thirty patients who underwent 3-dimensional computed tomography (3D-CT) preceding catheter ablations for atrial fibrillation were enrolled in this study. We used the skin surface 1 cm below the xiphisternum as the puncture site. For the anterior approach, the attainment site was the pericardium of the mid portion of right ventricular anterior site, and for the posterior approach it was the pericardium of the inferior ventricular site. The distance and the angle between the 2 sites were measured using 3D-CT. Results: For the anterior approach, the distance was 54711 mm and the needle angle was 377111 toward the left scapula and 347121 towards the back of the body. For the posterior approach, the distance was 56710 mm and the corresponding needle angles were 60791 and 867131. The distance correlated with BMI for the anterior and posterior approaches (anterior approach: r 2 ¼0.43, Po0.001; posterior approach: r 2 ¼0.49, Po0.001). Liver existed along the pathway of the posterior approach in 11 (37%) of 30 patients, and through in 2 (18%) of 11 patients. The liver and lung were not located along the pathway of the anterior approach in any patients. Conclusions: Performing subxiphoid pericardiocentesis is anatomically safer via the anterior approach than via the posterior approach.

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Catheter ablation for ventricular tachycardia after failed endocardial ablation: Epicardial substrate or inappropriate endocardial ablation?

Cited by 119 publications

References 35 publications

Epicardial Ablation of Ventricular Tachycardia

Epicardial Ablation of Ventricular Tachycardia

Long‐term outcomes of catheter ablation of ventricular tachycardia in patients with structural heart disease

Anatomical consideration for safe pericardiocentesis assessed by three‐dimensional computed tomography: Should an anterior or posterior approach be used?

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