Epicardial Catheter Ablation of Ventricular Tachycardia in No Entry Left Ventricle

Abstract

the His recording site, coronary sinus and right ventricular apex. Programmed stimulation was performed to identify the target VT. Bundle branch re-entry or VT originating from the right ventricle was ruled out. If the VT was from the LV, a surgical pericardial window was used as an access to the epicardium with anticipation of pericardial adhesions. A 3-dimensional electroanatomical mapping system (Carto system, Biosense Webster, or EnSite NavX, St. Jude Medical) was used to identify the substrate and map the VT if allowed. Sites with abnormal potentials, such as fractionated signals, © 2015 American Heart Association, Inc. Original ArticleBackground-In patients with mechanical aortic and mitral valves and left ventricular tachycardia, catheter ablation may be prevented by limited access to the left ventricle. Methods and Results-In our series of 6 patients, 2 patients underwent direct surgical ablation and 4 underwent epicardial catheter ablation via a pericardial window. All patients had abnormal low voltage areas with fractionated or delayed isolated potentials on the apical epicardium. Most of the ventricular tachycardias were targeted by pace mapping. Sites with a good pace match or abnormal electrograms were ablated using an irrigated radiofrequency ablation catheter. A microscopic pathological evaluation of the resected tissue from 2 of the open-heart ablation patients revealed dense fibrosis on the epicardium compared with the endocardium, supporting the feasibility of an epicardial ablation for the ventricular tachycardia. Conclusions-Epicardial

Ventricular arrhythmias in nonischemic cardiomyopathy

“…The transseptal approach is effective in reaching most of the LV endocardium, whereas the retrograde aortic approach is more effective in accessing the basal septum, basal inferior, and basal lateral segments, and the aortic outflow tract 56. For conditions where entry into the LV is difficult, a percutaneous interventricular septal access, an epicardial approach, or a percutaneous transapical procedure will serve as a rescue procedure for those with mechanical aortic or mitral valves 57, 58, 59, 60. Steerable long sheaths can also provide additional support for difficult endocardial mapping and epicardial procedures 61.…”

Ablation of ventricular tachycardia by direct left ventricle puncture through a minithoracotomy after double valve replacement: a case report and literature review

“…Epicardial ablation in patients with double-valve replacement has been reported in a series of cases. [3][4][5][6][7] Although proven effective for VT originating from the epicardium, its application may be restricted by its lower efficacy in treating endocardial VT as well as severe adhesion of the pericardium caused by previous cardiac surgery. Ablation of the epicardial VT through the great cardiac vein 6 is also reportedly effective, but its applicability might be limited by an apical endocardium origin, as in our case.…”

Hybrid Catheter-Based and Surgical Techniques for Ablation of Ventricular Arrhythmias

“…Given that such patients tend to have non-ischaemic substrate with perivalvular/epicardial substrate, an approach for epicardial mapping and ablation would be desirable. [ 13 ]…”