Document Detail


Epicardial ablation of ventricular tachycardia: An institutional experience of safety and efficacy.
MedLine Citation:
PMID:  23246598     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Epicardial ablation has been shown to be a useful adjunct for treatment of ventricular tachycardia (VT). OBJECTIVE: To report the trends, safety and efficacy of epicardial mapping and ablation at a single center over an eight-year period. METHODS: Patients referred for VT ablation (6/2004-6/2011) were divided into three groups: ischemic cardiomyopathy (ICM), nonischemic cardiomyopathy (NICM), and idiopathic ventricular arrhythmias (VA). Scar-mediated VT patients that underwent combined epicardial and endocardial (epi-endo) mapping and ablation were compared with those that underwent endocardial ablation only (endo-only) with regards to patient characteristics, acute procedural success, 6 month and 12 month clinical outcomes. RESULTS: Amongst 144 patients referred for VT ablation, 95 patients underwent 109 epicardial procedures (94% access rate). Major complications were seen in 8 patients (8.8%) with pericardial bleeding (>80cc) in 6 cases (6.7%), although no tamponade, surgical intervention, or procedural mortality was seen. Patients with ICM who underwent a combined epi-endo ablation had improved freedom from VT compared to those with endo-only ablation at 12 months (85% vs 56%, p=0.03). In NICM patients, no differences were seen between those that underwent epi-endo ablation compared to those with endo-only ablation at 12 months (36% vs 33%, p=1.0). In idiopathic VA, only 2/17 patients were successfully ablated from the epicardium. CONCLUSIONS: In this large tertiary single-center experience, complication rates are acceptably low and improved clinical outcomes were associated with epi-endo ablation in ICM patients. NICM patients represent a growing referred population, although clinical recurrence remains high despite epicardial ablation. Epicardial ablation has a low yield in idiopathic VA.
Authors:
Roderick Tung; Yoav Michowitz; Ricky Yu; Nilesh Mathuria; Marmar Vaseghi; Eric Buch; Jason Bradfield; Osamu Fujimura; Jean Gima; William Discepolo; Ravi Mandapati; Noel Boyle; Kalyanam Shivkumar
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-11
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Inc.
Affiliation:
UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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