Epicardial Ventricular Tachycardia Ablation A Multicenter Safety Study

Objectives The aim of this study was to perform a systematic evaluation of safety and midterm complications after epicardial ventricular tachycardia (VT) ablation. Background Epicardial VT ablation is increasingly performed, but there is limited information about its safety and midterm complications. Methods All patients undergoing VT ablation at 3 tertiary care centers between 2001 and 2007 were included in this study. Of 913 VT ablations, 156 procedures (17%) involved epicardial mapping and/ or ablation. These were performed in 134 patients (109 men; mean age 56 +/- 15 years) after a previous VT ablation in 115 (86%). The underlying substrates were ischemic cardiomyopathy in 51 patients, nonischemic cardiomyopathy in 39 patients, arrhythmogenic right ventricular cardiomyopathy in 14 patients, and other types of cardiomyopathy in 30 patients. Results Epicardial access was obtained via percutaneous subxiphoid puncture in 136 procedures, by a surgical subxiphoid approach in 14, and during open-heart surgery in 6. Epicardial ablation (mean radiofrequency duration: 13 +/- 12 min; median: 10 min) was performed in 121 of 156 procedures (78%). Twenty patients subsequently required repeat procedures, and the epicardium could be reaccessed in all but 1 patient. A total of 8 (5%) major complications related to pericardial access were observed acutely: 7 epicardial bleeding (>80 cm(3)) and 1 coronary stenosis. After a mean follow-up period of 23 +/- 21 months, 3 delayed complications related to pericardial access were noted: 1 major pericardial inflammatory reaction, 1 delayed tamponade, and 1 coronary occlusion 2 weeks after the procedure. Conclusions VT ablation required epicardial ablation in 121 of 913 procedures (13%), with a risk of 5% and 2% of acute and delayed major complications related to epicardial access. (J Am Coll Cardiol 2010;55:2366-72) (C) 2010 by the American College of Cardiology Foundation