Epicardial ablation of ventricular tachycardia: An institutional experience of safety and efficacy

BACKGROUND Epicardial ablation has been shown to be a useful adjunct for treatment of ventricular tachycardia (VT). OBJECTIVE To report the trends, safety, and efficacy of epicardial mapping and ablation at a singe center over an 8-year period. METHODS Patients referred for VT ablation (June 2004 to Jury 2011) were divided into 3 groups: ischemic cardiomyopathy (ICM), nonischemic cardiomyopathy (NICM), and idiopathic ventricular arrhythmias (VA). Patients with scar-mediated VT who underwent combined epicardial and endocardial (epi-endo) mapping and ablation were compared with those who underwent endocardial-only (endo-only) ablation with regard to patient characteristics, acute procedural success, 6- and 12-month clinical outcomes. RESULTS Among 144 patients referred for VT ablation, 95 patients underwent 109 epicardial procedures (94% access rate). Major complications were seen in 8 patients (8.8%) with pericardial breeding (>80 cm(3)) in 6 cases (6.7%), although no tamponade, surgical intervention, or procedural mortality was seen. Patients with ICM who underwent a combined epi-endo ablation had improved freedom from VT compared with those who underwent endo-only ablation at 12 months (85% vs 56%; P = .03). In patients with NICM, no differences were seen between those who underwent epi-endo ablation and those who underwent endo-only ablation at 12 months (36% vs 33%; P = 1.0). In idiopathic VA, only 2 of 17 patients were successfully abated from the epicardium. CONCLUSIONS In this Large tertiary singe-center experience, complication rates are acceptably Low and improved clinical. outcomes were associated with epi-endo ablation in patients with ICM. Patients with NICM represent a growing referred population, although clinical. recurrence remains high despite epicardial ablation. Epicardial ablation has a Low yield in idiopathic VA.