Necessity of epicardial ablation for ventricular tachycardia after sequential endocardial approach

Sultan, Arian; Lüker, Jakob; Hoffmann, Boris; Servatius, Helge Simon; Aydin, Ali; Nührich, Jana; Akbulak, Özge; Schreiber, Doreen; Schäffer, Benjamin; Rostock, Thomas; Willems, Stephan; Steven, Daniel (2014). Necessity of epicardial ablation for ventricular tachycardia after sequential endocardial approach. International journal of cardiology, 182, pp. 56-61. Elsevier 10.1016/j.ijcard.2014.12.003

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Background Catheter ablation (CA) of ventricular tachycardia (VT) is an important treatment option in patients with structural heart disease (SHD) and implantable cardioverter defibrillator (ICD). A subset of patients requires epicardial CA for VT. Objective The purpose of the study was to assess the significance of epicardial CA in these patients after a systematic sequential endocardial approach. Methods Between January 2009 and October 2012 CA for VT was analyzed. A sequential CA approach guided by earliest ventricular activation, pacemap, entrainment and stimulus to QRS-interval analysis was used. Acute CA success was assessed by programmed ventricular stimulation. ICD interrogation and 24 h-Holter ECG were used to evaluate long-term success. Results One hundred sixty VT ablation procedures in 126 consecutive patients (114 men; age 65 ± 12 years) were performed. Endocardial CA succeeded in 250 (94%) out of 265 treated VT. For 15 (6%) VT an additional epicardial CA was performed and succeeded in 9 of these 15 VT. Long-term FU (25 ± 18.2 month) showed freedom of VT in 104 pts (82%) after 1.2 ± 0.5 procedures, 11 (9%) suffered from repeated ICD shocks and 11 (9%) died due to worsening of heart failure. Conclusions Despite a heterogenic substrate for VT in SHD, endocardial CA alone results in high acute success rates. In this study additional epicardial CA following a sequential endocardial mapping and CA approach was performed in 6% of VT. Thus, due to possible complications epicardial CA should only be considered if endocardial CA fails.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Kardiologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Kardiologie

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Servatius, Helge Simon

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0167-5273

Publisher:

Elsevier

Language:

English

Submitter:

PD Dr. Helge Simon Servatius

Date Deposited:

07 Apr 2015 13:53

Last Modified:

29 Oct 2015 09:35

Publisher DOI:

10.1016/j.ijcard.2014.12.003

PubMed ID:

25576719

BORIS DOI:

10.7892/boris.66371

URI:

https://boris.unibe.ch/id/eprint/66371

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