Feasibility and Safety of Laparoscopic‐Guided Epicardial Access for Ventricular Tachycardia Ablation

Background The usual approach to epicardial access in patients with Chagas cardiomyopathy and megacolon is surgical access to avoid bowel injury. However, there are concerns regarding its safety in cases of Chagas cardiomyopathy with reports of prolonged mechanical ventilation and high mortality in this clinical setting. The aim of this study was to examine feasibility and complication rates for ventricular tachycardia ablation performed with laparoscopic‐guided epicardial access. Methods and Results This single center study examined complication rates of the first 11 cases of ventricular tachycardia ablation in patients with Chagas cardiomyopathy, using laparoscopic guidance to access epicardial space. All 11 patients underwent epicardial VT ablation using laparoscopic‐guided epicardial access, and the complication rates were compared with historical medical reports. The main demographic features of our population were age, 63±13 years; men, 82%; and median ejection fraction, 31% (Q1=30% and Q3=46%). All patients were sent for ventricular tachycardia ablation because of medical therapy failure. The reason for laparoscopy was megacolon in 10 patients and massive liver enlargement in 1 patient. Epicardial access was achieved in all patients. Complications included 1 severe cardiogenic shock and 1 phrenic nerve paralysis. No intra‐abdominal organ injury occurred; only 1 death, which was caused by progressive heart failure, was reported more than 1 month after the procedure. Conclusions Laparoscopic‐guided epicardial access in the setting of ventricular tachycardia ablation and enlarged intra‐abdominal organ is a simple alternative to more complex surgical access and can be performed with low complication rates.

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Left anterior descending coronary artery dissection during ventricular tachycardia ablation – case report

Romanian Journal of Internal Medicine ◽

10.1515/rjim-2017-0030 ◽

2018 ◽

Vol 56 (1) ◽

pp. 63-66

Author(s):

Kresimir Kordic ◽

Sime Manola ◽

Ivan Zeljkovic ◽

Ivica Benko ◽

Nikola Pavlovic

Keyword(s):

Ventricular Tachycardia ◽

Coronary Artery ◽

Left Main Coronary Artery ◽

Left Ventricular ◽

Artery Dissection ◽

Complication Rates ◽

Left Main ◽

Coronary Artery Dissection ◽

Ventricular Tachycardia Ablation ◽

First Case

Abstract Fascicular left ventricular tachycardia (VT) is the second most frequent idiopathic left VT in the setting of a structurally normal heart. Catheter ablation is curative in most patients with low complication rates. We report a case of ostial left anterior descending coronary artery (LAD) occlusion during fascicular ventricular tachycardia ablation. Dissection was the most likely cause of LAD obstruction. To the authors’ best knowledge, this is the first case reporting selective LAD dissection during electrophysiology study with no left main coronary artery (LMCA) affection.

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Epicardial Access for Ventricular Tachycardia Ablation: Experience With the Needle-in-needle Technique

Revista Española de Cardiología (English Edition) ◽

10.1016/j.rec.2019.03.003 ◽

2019 ◽

Vol 72 (10) ◽

pp. 873-874

Author(s):

Ignasi Anguera ◽

Marta Aceña ◽

Zoraida Moreno-Weidmann ◽

Paolo D. Dallaglio ◽

Andrea Di Marco ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Ventricular Tachycardia Ablation ◽

Needle Technique ◽

Epicardial Access

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Complication rates following ventricular tachycardia ablation in ischaemic and non-ischaemic cardiomyopathies: a systematic review

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-021-00948-6 ◽

2021 ◽

Author(s):

Wern Yew Ding ◽

Charles M. Pearman ◽

Laura Bonnett ◽

Ahmed Adlan ◽

Shui Hao Chin ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Vascular Complications ◽

Major Complication ◽

Complication Rates ◽

Ventricular Tachycardia Ablation ◽

Ischaemic Cardiomyopathy ◽

Cerebrovascular Events ◽

Acute Complications ◽

Vt Ablation

Abstract Background Catheter ablation of ventricular tachycardia (VT) is associated with potential major complications, including mortality. The risk of acute complications in patients with ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM) has not been systematically evaluated. Methods PubMed was searched for studies of catheter ablation of VT published between September 2009 and September 2019. Pre-specified primary outcomes were (1) rate of major acute complications, including death, and (2) mortality rate. Results A total of 7395 references were evaluated for relevance. From this, 50 studies with a total of 3833 patients undergoing 4319 VT ablation procedures fulfilled the inclusion criteria (mean age 59 years; male 82%; 2363 [62%] ICM; 1470 [38%] NICM). The overall major complication rate in ICM cohorts was 9.4% (95% CI, 8.1–10.7) and NICM cohorts was 7.1% (95% CI, 6.0–8.3). Reported complication rates were highly variable between studies (ICM I2 = 90%; NICM I2 = 89%). Vascular complications (ICM 2.5% [95% CI, 1.9–3.1]; NICM 1.2% [95% CI, 0.7–1.7]) and cerebrovascular events (ICM 0.5% [95% CI, 0.2–0.7]; NICM, 0.1% [95% CI, 0–0.2]) were significantly higher in ICM cohorts. Acute mortality rates in the ICM and NICM cohorts were low (ICM 0.9% [95% CI, 0.5–1.3]; NICM 0.6% [95% CI, 0.3–1.0]) with the majority of overall deaths (ICM 75%; NICM 80%) due to either recurrent VT or cardiogenic shock. Conclusion Overall acute complication rates of VT ablation are comparable between ICM and NICM patients. However, the pattern and predictors of complications vary depending on the underlying cardiomyopathy.

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Epicardial access and ventricular tachycardia ablation in a postmyocarditis patient using a nonfluoroscopic catheter visualization system

HeartRhythm Case Reports ◽

10.1016/j.hrcr.2017.05.003 ◽

2017 ◽

Vol 3 (9) ◽

pp. 411-414 ◽

Cited By ~ 1

Author(s):

Akiko Ueda ◽

Mika Nagaoka ◽

Kyoko Soejima ◽

Yosuke Miwa ◽

Noriko Matsushita

Keyword(s):

Ventricular Tachycardia ◽

Visualization System ◽

Ventricular Tachycardia Ablation ◽

Epicardial Access

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Epicardial Ventricular Tachycardia Ablation for Which Patients?

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2012.1.39 ◽

2012 ◽

Vol 1 ◽

pp. 39 ◽

Cited By ~ 2

Author(s):

Laurent Roten ◽

Frédéric Sacher ◽

Matthew Daly ◽

Patrizio Pascale ◽

Yuki Komatsu ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Implantable Cardioverter Defibrillators ◽

First Line ◽

Ventricular Tachycardia Ablation ◽

Number Of Patients ◽

Vt Ablation ◽

Patients Experience ◽

Cardioverter Defibrillators ◽

First Line Treatment ◽

Epicardial Access

With the widespread use of implantable cardioverter-defibrillators, an increasing number of patients present with ventricular tachycardia (VT). Large multicentre studies have shown that ablation of VT successfully reduces recurrent VT and this procedure is being performed by an increasing number of centres. However, for a number of reasons, many patients experience VT recurrence after ablation. One important reason for VT recurrence is the presence of an epicardial substrate involved in the VT circuit which is not affected by endocardial ablation. Epicardial access and ablation is now frequently performed either after failed endocardial VT ablation or as first-line treatment in selected patients. This review will focus on the available evidence for identifying VT of epicardial origin, and discuss in which patients an epicardial approach would be benefitial.

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