Percutaneous Epicardial Ablation of Ventricular Tachycardia After Failure of Endocardial Approach in the Pediatric Population With Arrhythmogenic Right Ventricular Dysplasia

Epicardial ablation of tachyarrhythmia in children: Experience at two academic centers

“…The epicardial approach for ablation of tachyarrhythmias in children is uncommon. Reported case series in children to date have been for failed endocardial ablation of VT and AT . This series is similar to those reported, but adds to the literature by: including patients with WPW, demonstrating the interaction between using both endocardial and epicardial approaches in practice, and adding additional safety and efficacy to the sparse pediatric literature.…”

“…Use of epicardial ablation in children is uncommon and reported data are limited to small case series and case reports involving VT and atrial tachycardia (AT) . The largest reported pediatric series described the use of epicardial techniques for arrhythmogenic right ventricular dysplasia (ARVD) in 17 patients . This study contributes to the assessment of the feasibility, efficacy, and safety of epicardial catheter ablation for a variety of arrhythmia mechanisms in the pediatric population at two academic medical centers.…”

“…Percutaneous epicardial access for ablation of epicardially located tachycardia foci has been used with good success and acceptable risks for ventricular tachycardia (VT) in adults . Use of epicardial ablation in children is uncommon and reported data are limited to small case series and case reports involving VT and atrial tachycardia (AT) . The largest reported pediatric series described the use of epicardial techniques for arrhythmogenic right ventricular dysplasia (ARVD) in 17 patients .…”

PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease

“…Sustained monomorphic VT is typically due to scar-related reentry, but focal origin VTs also occur. 127 Scarring is more extensive in the epicardium than the endocardium, and ablation from the epicardium is frequently required. 127,128 Experience in children is limited.…”

Epicardial Ventricular Tachycardia Ablation for Which Patients?

“…24,25 Different groups have reported high rates of arrhythmia-free outcome with combined endo-and epicardial substrate ablation in ARVC/D patients. [24][25][26] Two non-randomised, multicentre studies compared outcomes of ARVC/D patients treated with combined endo-epicardial ablation versus exclusive endocardial ablation; both found significantly higher long-term freedom from recurrent VT in the groups treated with combined ablation. 27,28 Because of the unique pathology of ARVC/D, epicardial scar plays a major role in VT origin; important parts of re-entry circuits may lie epicardially in this patient population.…”