Left-lateral thoracotomy for catheter ablation of scar-related ventricular tachycardia in patients with inaccessible pericardial access
Open Access
- 26 May 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Clinical Research in Cardiology
- Vol. 110 (6), 801-809
- https://doi.org/10.1007/s00392-020-01670-5
Abstract
Objectives We aimed to describe the feasibility of a surgical left thoracotomy for catheter ablation of scar-related ventricular tachycardia (VT) in patients with inaccessible pericardial access. Background Pericardial adhesion due to prior cardiac surgery or previous epicardial ablation procedures limits epicardial access in patients with drug-refractory VT originated from the epicardium. Methods Six patients who underwent a surgical left lateral thoracotomy epicardial access for catheter ablation of VT after failed subxiphoid percutaneous epicardial access were reviewed. Patients’ baseline characteristics and procedural characteristics including epicardial access, mapping, and ablation were described. Epicardial access was successfully obtained in all patients by a surgical left lateral thoracotomy. Results The reasons of pericardial adhesion were prior cardiac surgery (n = 3, 50%) and previous epicardial ablation procedures (n = 3, 50%). Epicardial mapping of the lateral and inferior left ventricle was acquired, and a total of 15 different VTs originated from those regions were abolished. Unless one patient with ST elevation myocardial infarction due to periprocedural occlusion of the posterior descending artery no further complications occurred. All patients were discharged 10.2 ± 4 days after the procedure. VT recurred in 1 patient (17%) and was controlled with oral amiodarone therapy during follow-up (median follow-up: 479 days). Conclusions A surgical left lateral thoracotomy is feasible and safe for selected patients. This approach provides epicardial ablation in patients with VT located at the infero-lateral left ventricle and pericardial adhesions due to previous cardiac surgery or previous ablation procedures. Graphic abstractKeywords
This publication has 24 references indexed in Scilit:
- Epicardial Phrenic Nerve Displacement During Catheter Ablation of Atrial and Ventricular ArrhythmiasCirculation: Arrhythmia and Electrophysiology, 2015
- Catheter Ablation of Ventricular Arrhythmia in Nonischemic CardiomyopathyCirculation: Arrhythmia and Electrophysiology, 2014
- Electrical isolation of a substrate after myocardial infarction: a novel ablation strategy for unmappable ventricular tachycardias--feasibility and clinical outcomeEP Europace, 2014
- Repeat Percutaneous Epicardial Mapping and Ablation of Ventricular Tachycardia: Safety and OutcomeJournal of Cardiovascular Electrophysiology, 2012
- Catheter ablation for ventricular tachycardia after failed endocardial ablation: Epicardial substrate or inappropriate endocardial ablation?Heart Rhythm, 2010
- Hybrid procedures for epicardial catheter ablation of ventricular tachycardia: Value of surgical accessHeart Rhythm, 2010
- Epicardial Ventricular Tachycardia Ablation: A Multicenter Safety StudyJournal of the American College of Cardiology, 2010
- Subxiphoid Surgical Approach for Epicardial Catheter-Based Mapping and Ablation in Patients With Prior Cardiac Surgery or Difficult Pericardial AccessCirculation, 2004
- Endocardial and epicardial radiofrequency ablation of ventricular tachycardia associated with dilated cardiomyopathy: The importance of low-voltage scarsJournal of the American College of Cardiology, 2004
- Electrically Unexcitable Scar Mapping Based on Pacing Threshold for Identification of the Reentry Circuit IsthmusCirculation, 2002