Document Detail

Percutaneous epicardial mapping during ablation of difficult accessory pathways as an alternative to cardiac surgery.
MedLine Citation:
PMID:  15851176     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The aim of this study was to define the role of percutaneous epicardial mapping for the ablation of previous failed ablation of accessory pathways. BACKGROUND: Cardiac surgery is the only curative option for failed radiofrequency (RF) catheter ablation of accessory pathway (AP)-mediated tachycardias. We investigated a combined percutaneous epicardial and endocardial approach for failed AP ablations. METHODS: We present our experience in a series of 6 cases (7 APs) with previous failed attempts at catheter ablation (median 2 attempts, range 1-4) and persistent symptomatic tachycardias. Endocardial mapping of the APs was performed using conventional techniques. Sites with local electrograms suggestive of AP location were selected. When initial endocardial mapping was not successful for ablation of the pathway, percutaneous transthoracic pericardial puncture was performed via a subxiphoid approach, and an ablation catheter was positioned at the epicardial aspect of the putative AP location for epicardial-endocardial electrogram comparison. Endocardial RF energy was applied to locations considered appropriate. Epicardial RF applications were delivered when endocardial applications failed. Coronary arteriography was performed to assess the proximity of coronary arteries to the ablation catheter. RESULTS: APs were located in the right free wall (4 patients, 5 APs) and the right (1 patient) and left (1 patient) posteroseptal regions. In all patients, epicardial mapping assisted in identifying successful ablation sites. In 3 patients, the earliest atrial activation during orthodromic tachycardia was present in an epicardial electrogram. Successful AP ablation was achieved with an epicardial RF application in 2 patients, either alone or with simultaneous endocardial-epicardial delivery. In the remaining 4 patients, APs were successfully ablated endocardially after epicardial mapping. These patients represent 18% of all cases referred to our institution for ablation of previously failed accessory pathways (6/32 patients). CONCLUSIONS: A combined endocardial-epicardial approach to mapping and RF ablation can facilitate successful endocardial ablation in most cases. In selected cases, APs can be ablated by epicardial delivery of RF. Epicardial mapping is an effective alternative to cardiac surgery for patients in whom prior attempts at AP ablation have failed.
Miguel Valderrábano; David A Cesario; Sen Ji; Kevin Shannon; Isaac Wiener; Charles D Swerdlow; Hakan Oral; Fred Morady; Kalyanam Shivkumar
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  1     ISSN:  1547-5271     ISO Abbreviation:  Heart Rhythm     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2005-04-26     Completed Date:  2005-06-28     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  311-6     Citation Subset:  IM    
UCLA Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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MeSH Terms
Body Surface Potential Mapping / methods*
Catheter Ablation / methods*
Endocardium / physiopathology
Heart Conduction System / physiopathology*,  surgery*
Middle Aged
Pericardium / physiopathology*
Retrospective Studies
Tachycardia / physiopathology,  surgery*
Treatment Failure

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

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