Percutaneous epicardial ablation in ventricular arrhythmias

Introduction: Reentrant circuits of ventricular tachycardia may involve not only the endocardium but also the epicardium. Epicardial ablation can be useful in these situations.

Objective: The aim of this study was to assess efficacy, safety and complications in a series of consecutive patients who underwent ablation of ventricular tachycardia with epicardial mapping.

Methods: The study included all patients undergoing ventricular tachycardia ablation with epicardial mapping from 2004 to 2012. Of a total of 95 ablations, an epicardial approach was attempted in nine patients, eight male, mean age 58±12 years. Endocardial mapping was performed in all patients previously or simultaneously. The etiology of the arrhythmia was non-ischemic in eight patients and ischemic in one. We compared the number of events in the six months prior to the epicardial procedure and six months after.

Results: Percutaneous epicardial access was achieved in eight patients. In one case it was not possible due to the presence of adhesions. In none of the patients was the procedure repeated and there were no major complications during hospitalization. In a mean follow-up of 3.5±1.2 years, one patient suffered stroke; there were no other medium-to-long-term complications and the number of ventricular tachycardia episodes was reduced in all patients after ablation.

Conclusions: Epicardial radiofrequency ablation of ventricular tachycardia was effective in reducing morbidity in eight patients, with a low risk of complications in the short and medium-to-long term.