Work

Epicardial access for ventricular tachycardia and premature ventricular complexes ablation: An institutional experience

Year: 2024

Type: article

Abstract: 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.

Source: Heart Rhythm O2

DOI: 10.1016/j.hroo.2024.11.020