Related Experiment Video

Updated: Apr 18, 2026

Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction
06:57

Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction

Published on: January 31, 2019

15.6K

Necessity of epicardial ablation for ventricular tachycardia after sequential endocardial approach

Arian Sultan1, Jakob Lüker1, Boris Hoffmann2

  • 1University of Cologne, Heart Center, Department of Electrophysiology, Germany.

International Journal of Cardiology
|January 11, 2015
PubMed

Insights

Epicardial catheter ablation (CA) for ventricular tachycardia (VT) is effective in a small subset of patients after endocardial CA fails. This approach achieved success in 9 of 15 VT cases, highlighting its role when the primary endocardial treatment is insufficient.

Area of Science:

  • Electrophysiology
  • Cardiology
  • Cardiac Ablation

Background:

  • Catheter ablation (CA) is a key treatment for ventricular tachycardia (VT) in patients with structural heart disease (SHD) and implantable cardioverter defibrillators (ICDs).
  • A subset of patients with VT requires epicardial CA, necessitating evaluation after endocardial approaches.

Purpose of the Study:

  • To evaluate the significance and success rate of epicardial CA for VT.
  • To assess its utility following a systematic sequential endocardial ablation strategy.

Main Methods:

  • Analysis of 160 VT ablation procedures in 126 patients (2009-2012).
  • Sequential endocardial CA guided by earliest ventricular activation, pacemap, entrainment, and stimulus-to-QRS interval.
  • Acute success assessed by programmed ventricular stimulation; long-term success by ICD interrogation and 24h-Holter ECG.

Main Results:

  • Endocardial CA succeeded in 94% of treated VT.
  • Epicardial CA was additionally performed in 6% of VT cases, succeeding in 9 out of 15.
  • Long-term follow-up (25 months) showed 82% freedom from VT, with 9% experiencing recurrent ICD shocks and 9% mortality.

Conclusions:

  • Endocardial CA alone achieves high acute success rates for VT in SHD.
  • Additional epicardial CA is required in a small percentage (6%) of VT cases after endocardial failure.
  • Epicardial CA should be reserved for cases where endocardial ablation is unsuccessful due to potential complications.
Abstract

Keywords:
Epicardial ablation in structural heart disease

More Related Videos

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing12:45

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

11.1K
Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System10:17

Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System

Published on: April 11, 2025

2.3K

Related Concept Videos

ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias01:25

ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias

Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
1.1K
Cardiopulmonary Resuscitation III: AED Use01:23

Cardiopulmonary Resuscitation III: AED Use

Introduction to AEDAn Automated External Defibrillator (AED) is a portable medical device that analyzes the heart's rhythm and, if necessary, delivers an electrical shock to help the heart re-establish an effective rhythm during sudden cardiac arrest (SCA). SCA occurs when the heart suddenly and unexpectedly stops beating, leading to a loss of blood flow to the brain and other vital organs. In such emergencies, time is of the essence, and using an AED, combined with Cardiopulmonary...
1.6K
Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
724
Dysrhythmias VI: Management of Dysrhythmias01:25

Dysrhythmias VI: Management of Dysrhythmias

Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...
640
Cardiopulmonary Resuscitation IV: Pharmacological Management01:25

Cardiopulmonary Resuscitation IV: Pharmacological Management

Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
1.5K