Epicardial Interventions in Electrophysiology

Boyle, Noel G.; Shivkumar, Kalyanam

doi:10.1161/circulationaha.111.060327

Cited by 57 publications

(32 citation statements)

References 125 publications

(138 reference statements)

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“…In 2011 Nademanee et al 4 published a case series of 9 symptomatic patients with BrS who had recurrent VF episodes and ICD discharges who underwent epicardial ablation of the right ventricular outflow tract (RVOT). As Sacher et al 5 discovered later and then published by Boyle and Shivkumar 6 , in this location low voltages with prolonged duration and fractionated late potentials were found, and preliminary studies have shown an absence of clinical recurrence after the procedure of 78% in a 20-month follow-up 7, 8, 9…”

Section: Introductionmentioning

confidence: 52%

Epicardial mapping and ablation of the right ventricle substrate during flecainide testing in Brugada syndrome

González‐Melchor¹,

Brugada

Martínez‐Sande³

et al. 2016

HeartRhythm Case Reports

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Section: Introductionmentioning

confidence: 52%

Epicardial mapping and ablation of the right ventricle substrate during flecainide testing in Brugada syndrome

González‐Melchor¹,

Brugada

Martínez‐Sande³

et al. 2016

HeartRhythm Case Reports

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“…However, percutaneous pericardial access is now commonly used for epicardial ablation of arrhythmias and can be safely achieved in patients without previous cardiac surgery or pericardial disease. 5 In this study using canine models, successful placement of a novel IPL in a desired location in the pericardial space to overlie the posterior lateral LV was successfully achieved in all 12 dogs.…”

Section: Discussionmentioning

confidence: 72%

“…17 Nevertheless, a dry pericardial tap can be associated with complications that include intra-abdominal bleeding, laceration of the liver, injury to the coronary arteries, and cardiac perforation. 5,[17][18][19] RV puncture is the most common complication encountered in 4.5% of 215 consecutive cases in a series by Sosa et al 20 However, RV puncture rarely causes continued bleeding and often seals spontaneously. In the absence of previous pericardial inflammation or cardiac surgery, catheters and sheaths can be moved about freely within the pericardial space to deploy a lead in a desired area.…”

Section: Discussionmentioning

confidence: 99%

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Acute and Chronic Performance Evaluation of a Novel Epicardial Pacing Lead Placed by Percutaneous Subxiphoid Approach in a Canine Model

John

Morgan

Brennecke

et al. 2015

Circ: Arrhythmia and Electrophysiology

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The basic design for the intrapericardial leads (IPLs) used a diamond-shaped loop for stability at the distal end and a preshaped lead body within the diamond loop in which the bipolar, nonsteroid eluting, electrodes were located (Figure 1). The electrodes were titanium nitride-coated platinum iridium, 5 mm 2 in dimension © 2015 American Heart Association, Inc. Original ArticleBackground-Endovascularly implanted leads risk vascular injury and endocarditis, and can be difficult to locate in desired positions for LV pacing. We evaluated the acute and long-term stability, electric performance and histopathology of a percutaneously placed intrapericardial lead (IPL). Methods and Results-Twelve adult mongrel dogs underwent defibrillator implants incorporating IPLs. Successful uncomplicated percutaneous implantation of an IPL was achieved in all. Early fluoroscopic shift noted with 3 of 6 of the initial version IPL-1 was not seen with the modified IPL-2. Mean±95% confidence interval bipolar capture threshold at 0.5-ms pulse width for the IPL increased from 0.69±0.14 V at implant to 1.50±0.34 V (P=0.003) at 12 weeks. The 12-week thresholds were higher for IPL compared with right ventricular endocardial leads (0.75±0.33 V; P=0.001) but not different compared with coronary sinus leads (1.33±0.58 V; P=0.994). IPL impedance increased from 742±46 Ω at implant to 1066±207 Ω at 12 weeks (P=0.007). R-wave amplitude at 12 weeks was 8.37±1.52 mV. There was no important phrenic nerve stimulation from IPL pacing. Histopathology in 8 animals showed adequate adhesion of the electrodes or mesh to the epicardium without damage to underlying vasculature. There was no evidence for late pericardial inflammation or effusion. Conclusions-The IPL demonstrated adequate stability of position and acceptable electric parameters without chronic pericardial inflammation in this canine model and offers a potential alternative to endocardial pacing leads.

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“…Additionally, it may be considered based on a high pretest probability of midmyocardial or subepicardial scar, which is commonly seen in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC), dilated cardiomyopathy (DCM), and hypertrophic cardiomyopathy (HCM). 4,5 Magnetic resonance imaging and electrocardiographic criteria may be clinically useful when assessing for the presence of epicardial substrate ( Figure 1). As postinfarct scar follows a physiologic pattern of subendocardial necrosis that progresses towards the epicardium, it has been commonly thought that epicardial ablation has a lower yield in patients with ischemic cardiomyopathy.…”

Section: Indications For Epicardial Mapping and Ablationmentioning

confidence: 99%

Epicardial Ablation of Ventricular Tachycardia

Tung

Shivkumar

2015

Methodist DeBakey Cardiovascular Journal

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Epicardial mapping and ablation via a percutaneous subxiphoid technique has been instrumental in improving the working understanding of complex myocardial scars in various arrhythmogenic substrates. Endocardial ablation alone may not be sufficient in patients with ischemic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, hypertrophic cardiomyopathy, and Chagas disease to prevent recurrent ventricular tachycardia. Multiple observational studies have demonstrated greater freedom from recurrence with adjunctive epicardial ablation compared with endocardial ablation alone. While epicardial ablation is performed predominantly at tertiary referral centers, knowledge of the technical approach, clinical indications, and potential complications is imperative to maximizing clinical success and patient safety.In 1996, Sosa and colleagues modified the pericardiocentesis technique to enable percutaneous access to the pericardial space for mapping and catheter ablation of ventricular tachycardia.1 Originally developed for patients with epicardial scarring due to chagasic cardiomyopathy and patients with ischemic cardiomyopathy refractory to endocardial ablationm, 2,3 this approach has since become an essential part of the armamentarium for the treatment of ventricular tachycardia. Myocardial scars are three-dimensionally complex with varying degrees of transmurality, and the ability to map and ablate the epicardial surface has contributed to a greater understanding of scar-related VT in postinfarction cardiomyopathy and nonischemic substrates including idiopathic dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, hypertrophic cardiomyopathy, and chagasic cardiomyopathy. In this review, we highlight the percutaneous approach and discuss clinical indications and potential complications.

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Epicardial Interventions in Electrophysiology

Cited by 57 publications

References 125 publications

Epicardial mapping and ablation of the right ventricle substrate during flecainide testing in Brugada syndrome

Epicardial mapping and ablation of the right ventricle substrate during flecainide testing in Brugada syndrome

Acute and Chronic Performance Evaluation of a Novel Epicardial Pacing Lead Placed by Percutaneous Subxiphoid Approach in a Canine Model

Epicardial Ablation of Ventricular Tachycardia

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