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Published on: February 26, 2013
Epicardial access for ventricular tachycardia and premature ventricular complexes ablation: An institutional
Hema Srikanth Vemulapalli1, Juan F Rodriguez-Riascos1, Padmapriya Muthu1
1Division of Cardiovascular Diseases, Mayo Clinic Hospital, Phoenix, Arizona.
Insights
Epicardial access for ventricular ablation offers success in select cases, but long-term outcomes are suboptimal. Advanced disease and persistent inducibility predict poor results for ventricular arrhythmia ablation.
Area of Science:
- Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- Epicardial access for ventricular arrhythmia (VA) ablation is a complex and infrequently performed procedure.
- This approach is often considered when endocardial ablation strategies have failed or are not feasible.
Purpose of the Study:
- To evaluate the outcomes, success predictors, and complications of epicardial access during ventricular ablation.
- To identify factors influencing the success rates of epicardial ventricular ablation.
Main Methods:
- A multicenter, retrospective, observational study analyzing data from 2004-2024.
- Included 265 patients undergoing ventricular tachycardia (VT) or ventricular premature complex (PVC) ablation with epicardial access.
Main Results:
- Acute success (non-inducibility) was achieved in 61.7% of patients, with partial success in 29%.
- At a median follow-up of 61 months, 35.5% died, 13.3% underwent heart transplantation, and 31.6% required repeat ablation.
- One-year event-free survival was 50%.
Conclusions:
- Epicardial access can lead to successful ventricular ablation in specific patient groups.
- Advanced disease severity and residual inducibility post-ablation are linked to poorer long-term outcomes.
Background:
Epicardial access for ventricular arrhythmia (VA) ablation is a challenging and relatively uncommon procedure during ventricular ablation.
Objective:
This study aimed to assess the outcomes, predictors of success, and complications associated with pericardial access during these procedures.
Methods:
This multicenter, retrospective, observational study included data collected over 20 years (2004-2024) from all Mayo Clinic sites performing VA ablation with epicardial access.
Results:
A total of 265 patients were included in the analysis: 196 for VT ablation and 69 for PVC ablation. Among them, 184 (69%) had at least 1 previous VA ablation, 51 (19.2%) had ischemic cardiomyopathy, 53 (20%) had structurally normal hearts, and 164 (61.9%) had nonischemic cardiomyopathies (NICMs). Three presented with concomitant ischemic cardiomyopathy and NICM. Within the NICM group, the most common diagnoses were dilated cardiomyopathy (n = 80 [30.2%]), arrhythmogenic right ventricular cardiomyopathy (n = 34 [12.8%]), and sarcoidosis (n = 15 [5.7%]). Acute success, defined as noninducibility, was achieved in 100 (61.7%) of 162 patients tested, while partial success (clinical arrhythmia noninduciblility) was observed in 47 (29%). Before discharge, VT recurred in 20 patients (10.2%). During a median follow-up of 61 months, events were observed as follows: 60 (35.5%) patients died, 26 (13.3%) underwent heart transplantation, and 62 (31.6%) required a repeat ablation for VAs. The event-free survival rates were 50% (95% confidence interval 43%-58%) at 1 year.
Conclusion:
Successful VT ablation with epicardial access can be achieved in select cases, though event-free survival remains suboptimal. Advanced disease stage and persistent inducibility at the end of the procedure are predictors of poor outcomes.
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