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Percutaneous Epicardial Ventricular Tachycardia Ablation After Non-Coronary Cardiac Surgery or Pericarditis.
MedLine Citation:
PMID:  23059131     Owner:  NLM     Status:  Publisher    
BACKGROUND: Patients with previous non-coronary cardiac surgery or pericarditis may require epicardial access to facilitate successful VT ablation. Percutaneous pericardial access is known to be difficult in these patients due to the presence of pericardial adhesions. OBJECTIVE: To examine the success and safety of percutaneous pericardial access as well as the ability to map and ablate epicardial VT targets. METHODS: We studied ten consecutive patients with prior non-coronary cardiac surgery (8 patients) or prior pericarditis (2 patients) who required epicardial access for VT ablation. RESULTS: Percutaneous pericardial access was achieved by experienced operators and dense adhesions interfering with catheter mapping were encountered in all patients. Using blunt dissection with a deflected ablation catheter adhesions were divided over the course of 19-125 minutes (mean 57±38min, median 47min). This dissection allowed for sufficient epicardial mapping in 9/10 patients (90%). The clinical targeted VTs were rendered non-inducible in 8 (80%) patients. One patient had 70cc of bleeding with initial puncture. No other complications occurred. During long-term follow-up of 24±27 months (median 13 months), 5 patients have remained VT free. CONCLUSION: Percutaneous pericardial access for epicardial VT ablation in patients with previous non-coronary cardiac surgery or pericarditis can usually be obtained.  However, dense pericardial adhesions are often encountered and may limit the ability to map the entire epicardial space. Typically, appropriate targets can be reached and ablated by disrupting the adhesions with the ablation catheter and/or deflectable sheath facilitating excellent long-term clinical outcome in half of the patients with no major complications.
Cory M Tschabrunn; Haris M Haqqani; Joshua M Cooper; Sanjay Dixit; Fermin C Garcia; Edward P Gerstenfeld; David J Callans; Erica S Zado; Francis E Marchlinski
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-8
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-12     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.
Cardiac Electrophysiology Program, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine.
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