Epicardial ablation of ventricular tachycardias

被引：0

作者：

Ene E. ^{[1
]}

Halbfaß P. ^{[1
]}

Nentwich K. ^{[1
]}

Sonne K. ^{[1
]}

Roos M. ^{[1
]}

Fodor S. ^{[1
]}

Lehmkuhl L. ^{[1
]}

Gietzen F. ^{[1
]}

Barth S. ^{[1
]}

Hamm K. ^{[1
]}

Deneke T. ^{[1
]}

机构：

[1] Herz- und Gefäßklinik, Salzburger Leite 1, Bad Neustadt a. d. Saale

来源：

Herzschrittmachertherapie + Elektrophysiologie | 2017年 / 28卷 / 2期

关键词：

Electrical storm; Epicardial ablation; Nonischemic cardiomyopathy; Reentry mechanism; Substrate;

D O I：

10.1007/s00399-017-0501-7

中图分类号：

学科分类号：

摘要：

Ventricular tachycardias (VT) in patients with structural heart diseases have predominantly a scar-associated reentry mechanism so that substrate-based ablation approaches also have to be used in nearly all procedures. In many VT cases—especially in nonischemic cardiomyopathy (NICM) and arrhythmogenic right ventricular cardiomyopathy—a critical epicardial substrate can be identified as an essential component of the reentry circuit so that for the ablation-based modification of the substrate in these cases an epicardial approach is necessary. In cases of redo-VT ablation procedures in ischemic cardiomyopathy (after a previously endocardial ablation), an epicardial approach should also be considered. There are also cases in whom no endocardial substrate can be identified and an isolated epicardial substrate can be identified. Worldwide epicardial VT ablations are usually performed after gaining epicardial access using subxyphoidal puncture. The results of recent studies show a higher efficiency with stabilization of cardiac rhythm and reduction of recurrent VT episodes (about 70% event-free survival at the 2‑year follow-up) after endo-plus epicardial substrate modification. In electrical storm cases, an early epicardial VT ablation approach also appears to be relevant, especially in NICM. Epicardial instrumentation and ablation represents a complex procedure which should only be performed in experienced centers with cardiac surgery back-up. In these experienced centers, the complications rate is less than 5%. © 2017, Springer Medizin Verlag GmbH.

引用

页码：212 / 218

页数：6

共 20 条

[1] Priori S.G., Blomstrom-Lundqvist C., Mazzanti A., Blom N., Borggrefe M., Camm J., Elliott P.M., Fitzsimons D., Hatala R., Hindricks G., Kirchhof P., Kjeldsen K., Kuck K.H., Hernandez-Madrid A., Nikolaou N., Norekval T.M., Spaulding C., Van Veldhuisen D.J., ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the
[2] Tanner H., Hindricks G., Volkmer M., Furniss S., Kuhlkamp V., Lacroix D., de Chillou C., Almendral J., Caponi D., Kuck K.H., Kottkamp H., Catheter ablation of recurrent scar-related ventricular tachycardia using electroanatomical mapping and irrigated ablation technology: results of the prospective multicenter Euro-VT-study, J Cardiovasc Electrophysiol, 21, 1, pp. 47-53, (2010)
[3] Sapp J.L., Parkash R., Tang A.S., Ventricular tachycardia ablation versus antiarrhythmic-drug escalation, N Engl J Med, 375, 15, pp. 1499-1500, (2016)
[4] Carbucicchio C., Santamaria M., Trevisi N., Maccabelli G., Giraldi F., Fassini G., Riva S., Moltrasio M., Cireddu M., Veglia F., Della Bella P., Catheter ablation for the treatment of electrical storm in patients with implantable cardioverter-defibrillators: short- and long-term outcomes in a prospective single-center study, Circulation, 117, 4, pp. 462-469, (2008)
[5] Suzuki A., Yoshida A., Takei A., Fukuzawa K., Kiuchi K., Takami K., Itoh M., Imamura K., Fujiwara R., Nakanishi T., Yamashita S., Matsumoto A., Shimane A., Okajima K., Hirata K., Prophylactic catheter ablation of ventricular tachycardia before cardioverter-defibrillator implantation in patients with non-ischemic cardiomyopathy: Clinical outcomes after a single endocardial ablation, J Arrhythm, 31, 3, pp. 122-129, (2015)
[6] Chun K.R., Baensch D., Antz M., Koektuerk B., Kuck K.H., Catheter ablation for ventricular tachycardia after failed endocardial ablation: epicardial substrate or inappropriate endocardial ablation?, Heart Rhythm, 7, 12, pp. 1746-1752, (2010)
[7] Valles E., Bazan V., Marchlinski F.E., ECG criteria to identify epicardial ventricular tachycardia in nonischemic cardiomyopathy, Circ Arrhythm Electrophysiol, 3, pp. 63-71, (2009)
[8] Berruezo A., Mont L., Nava S., Chueca E., Bartholomay E., Brugada J., Electrocardiographic recognition of the epicardial origin of ventricular tachycardias, Circulation, 109, pp. 1842-1847, (2004)
[9] Oloriz T., Silberbauer J., Maccabelli G., Mizuno H., Baratto F., Kirubakaran S., Vergara P., Bisceglia C., Santagostino G., Marzi A., Sora N., Roque C., Guarracini F., Tsiachris D., Radinovic A., Cireddu M., Sala S., Gulletta S., Paglino G., Mazzone P., Trevisi N., Della Bella P., Catheter ablation of ventricular arrhythmia in nonischemic cardiomyopathy: anteroseptal versus inferolateral scar sub-types, Circ Arrhythm Electrophysiol, 7, pp. 414-423, (2014)
[10] Maccabelli G., Tsiachris D., Silberbauer J., Esposito A., Bisceglia C., Baratto F., Colantoni C., Trevisi N., Palmisano A., Vergara P., De Cobelli F., Del Maschio A., Della Bella P., Imaging and epicardial substrate ablation of ventricular tachycardia in patients late after myocarditis, Europace, 16, 9, pp. 1363-1372, (2014)

← 1 2 →