Document Detail

Nonsurgical transthoracic epicardial approach in patients with ventricular tachycardia and previous cardiac surgery.
MedLine Citation:
PMID:  15133368     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: The subxyphoid pericardial mapping approach can be used to facilitate catheter ablation of postmyocardial-infarction ventricular tachycardia (post-MI VT), but the presence of dense adhesions is thought to preclude this approach in patients who have previously undergone open-chest cardiac surgery. AIMS OF THE STUDY: This study reports the first use of a nonsurgical transthoracic epicardial approach in patients with scar-related VT and previous cardiac surgery. METHODS: Five patients with a mean age of 67 +/- 10 years, left ventricular ejection fraction (LVEF) of 40 +/- 4.3%) and recurrent VT occurring 7 months to 10 years after cardiac surgery underwent combined endocardial and epicardial mapping and ablation during the same session. Because pericardial adhesions were anticipated to be denser in the anterior wall, the nonsurgical transthoracic epicardial puncture was directed to the inferior wall of the left ventricle. Failure to interrupt VT with radio frequency (RF) energy pulses delivered at the best endocardial or epicardial site prompted changing from one approach to the other. RESULTS: During the epicardial puncture procedure, the contrast medium accumulated in the inferior wall instead of spreading around the cardiac silhouette. The pericardial sac could be entered in all patients, and mapping of the inferolateral epicardial wall of the left ventricle was feasible. Fourteen VTs were induced, of which 8 could not be mapped because of poor hemodynamic tolerance. Three of the remaining 6 mappable VTs were eliminated by endocardial ablation, 2 required an epicardial RF pulse to be rendered noninducible, and 1 VT was not eliminated. No intra- or postprocedural complications were noted despite full heparinization. CONCLUSION: Nonsurgical transthoracic epicardial catheter mapping and ablation of epicardial VT related to the inferolateral left ventricular wall are feasible in patients who have previously undergone open- cardiac surgery.
Eduardo Sosa; Mauricio Scanavacca; André D'Avila; José Antônio; Franchine Ramires
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing     Volume:  10     ISSN:  1383-875X     ISO Abbreviation:  J Interv Card Electrophysiol     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-05-10     Completed Date:  2004-11-08     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9708966     Medline TA:  J Interv Card Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  281-8     Citation Subset:  IM    
Unidade Clinica de Arritmia, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil.
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MeSH Terms
Aged, 80 and over
Body Surface Potential Mapping
Cardiac Surgical Procedures*
Catheter Ablation
Defibrillators, Implantable
Electrophysiologic Techniques, Cardiac
Follow-Up Studies
Heart Ventricles / surgery,  ultrasonography
Middle Aged
Pericardium / surgery*,  ultrasonography
Tachycardia, Ventricular / therapy*,  ultrasonography
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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