| Catheter ablation for ventricular tachycardia after failed endocardial ablation: epicardial substrate or inappropriate endocardial ablation? | |
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MedLine Citation:
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PMID: 20709191 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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BACKGROUND: The substrate of myocardial ventricular tachycardia (VT) may involve the subepicardial myocardium. OBJECTIVE: The purpose of this study was to assess the incidence of epicardial substrates in patients with a previously failed endocardial ablation attempt for VT as well as the safety and effectiveness of epicardial ablation. METHODS: Using an electroanatomic mapping system, endocardial and epicardial maps were acquired. Irrigated radiofrequency current ablations of all inducible VTs were performed. RESULTS: Between 2005 and 2009, 59 patients with or without structural heart disease underwent epicardial VT ablation. Pericardial access failed in 3 (5%) of these patients. Of the remaining 56 patients, an epicardial substrate was found in 41 (73%). Overall, acute success was achieved in 46 (78%) of 59 patients, with complete VT abolition in 27 (46%) and partial abolition in 19 (32%). Successful outcomes were the result of endocardial ablation only in 14 (24%) patients, epicardial ablation in 21 (36%), and endocardial/epicardial in 11 (19%). Ablation failed to prevent reinduction in 8 (13%) patients, and VTs were noninducible prior to ablation in 5 (8%). Two periprocedural deaths occurred, one after right ventricular perforation and one due to electromechanical dissociation. Hepatic bleeding occurred in two patients. Recurrence of any VT occurred in 27 (47%) of 57 surviving patients during median follow-up of 362 days (q1-q3; 180-468 days). Repeat epicardial mapping was not feasible due to adhesions in 3 (25%) of 12 patients. CONCLUSION: In patients with a previously failed endocardial VT ablation, epicardial mapping reveals a VT substrate in nearly three fourths of all patients, and epicardial ablation is required for successful VT abolition in more than half of patients. However, life-threatening complications may occur. Repeat epicardial access was not possible in 25% due to local pericardial adhesions. |
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Authors:
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Boris Schmidt; Kyong Ryoul Julian Chun; Dietmar Baensch; Matthias Antz; Buelent Koektuerk; Roland R Tilz; Andreas Metzner; Feifan Ouyang; Karl-Heinz Kuck |
Publication Detail:
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Type: Journal Article Date: 2010-08-13 |
Journal Detail:
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Title: Heart rhythm : the official journal of the Heart Rhythm Society Volume: 7 ISSN: 1556-3871 ISO Abbreviation: Heart Rhythm Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2010-12-06 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101200317 Medline TA: Heart Rhythm Country: United States |
Other Details:
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Languages: eng Pagination: 1746-52 Citation Subset: IM |
Copyright Information:
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Copyright © 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Asklepios Klinik St. Georg, Department of Cardiology, Hamburg, Germany. boris_schmidt@arcor.de |
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Comment In:
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Heart Rhythm. 2010 Dec;7(12):1753-4
[PMID:
20727421
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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