scholarly journals Epicardial Radiofrequency Ablation: Who, When, and How?

2021 ◽  
Author(s):  
Chin-Yu Lin
Keyword(s):  
Ventricular Tachycardia ◽  
Radiofrequency Ablation ◽  
Ischemic Cardiomyopathy ◽  
Imaging Modalities ◽  
Disease Entity ◽  
Potential Complication ◽  
Epicardial Mapping ◽  
Epicardial Ablation ◽  
The Past ◽  
Epicardial Access

In the past decades, it has been known that reentry circuits for ventricular tachycardia or focal triggers of premature ventricular complexes are not limited to the subendocardial myocardium. Rather, intramural or subepicardial substrates may also give rise to ventricular tachycardia, particularly in those with non-ischemic cardiomyopathy. Besides, some of the idiopathic ventricular tachycardia might be originated from epicardial foci. Percutaneous epicardial mapping and ablation have been successfully introduced to treat this sub-epicardiac ventricular tachycardia. Herein, this chapter reviews the indications for epicardial ablation and the identification of epicardial ventricular tachycardia by disease entity, electrocardiography and imaging modalities. This chapter also described the optimal technique for epicardial access and the potential complication.

scholarly journals Mapping and Surgical Ablation of Focal Epicardial Left Ventricular Tachycardia

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Arif Elvan ◽  
Hauw T. Sie ◽  
Anand R. Ramdat Misier ◽  
Andre C. Linnenbank ◽  
Peter Paul H. M. Delnoy ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Minimal Invasive ◽  
Left Ventricular ◽  
Lv Function ◽  
Ventricular Ectopy ◽  
Rf Ablation ◽  
Epicardial Mapping ◽  
Epicardial Ablation ◽  
Surgical Ablation ◽  
Technical Challenge

We describe a technical challenge in a 17-year-old patient with incessant epicardial focal ventricular arrhythmia and diminished LV function. Failure of ablation at the earliest activated endocardial site during ectopy suggested an epicardial origin, which was supported by specific electrocardiographic criteria. Epicardial ablation was not possible due to the localization of the origin of the ventricular tachycardia adjacent to the phrenic nerve. Minimal invasive surgical multielectrode high-density epicardial mapping was performed to localize the arrhythmia focus. Epicardial surgical RF ablation resulted in the termination of ventricular ectopy. After 2 years, the patient is still free from arrhythmias.

scholarly journals Imaging-guided Ventricular Tachycardia Ablation

2013 ◽  
Vol 2 (2) ◽  
pp. 128 ◽  
Author(s):  
Sebastiaan RD Piers ◽  
Katja Zeppenfeld ◽  
◽  
Keyword(s):  
Ventricular Tachycardia ◽  
Imaging Modalities ◽  
Epicardial Fat ◽  
Image Integration ◽  
Ventricular Tachycardia Ablation ◽  
The Past ◽  
Epicardial Fat Tissue ◽  
Vt Ablation ◽  
Anatomical Information ◽  
Made In

Over the past decades important advances have been made in the field of ventricular tachycardia (VT) ablation, and as a result, VT ablation is now more widely being performed. The identification of ablation target sites still relies on electroanatomical substrate mapping, which is time-consuming, hampered by the intramural location of some scars and limited by epicardial fat. The potential of various imaging modalities to overcome these limitations have stimulated clinical electrophysiologists to perform studies on image integration during VT ablation. Imaging guidance has been used to identify, delineate and characterise the substrate for VT; to provide detailed anatomical information; to avoid ablation on coronary arteries; to delineate epicardial fat tissue; and to assess ablation lesions. In this review, reported applications and the potential advantages and limitations of different imaging modalities are discussed.

Epicardial ablation of ventricular tachycardia via the aortic cusps in ischemic cardiomyopathy

2020 ◽  
Vol 73 (8) ◽  
pp. 685-687
Author(s):  
Rodolfo San Antonio ◽  
Francisco Alarcón ◽  
Eduard Guasch ◽  
José María Tolosana ◽  
Lluís Mont ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ischemic Cardiomyopathy ◽  
Epicardial Ablation

scholarly journals Epicardial voltage mapping in patients with postinfarction ventricular tachycardia: a pilot study

2020 ◽  
Vol 27 ◽  
pp. 22-27
Author(s):  
K. A. Simonova ◽  
E. N. Mikhaylov ◽  
R. B. Tatarskiy ◽  
A. V. Kamenev ◽  
D. V. Panin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ventricular Tachycardia ◽  
Low Voltage ◽  
Epicardial Mapping ◽  
Voltage Mapping ◽  
Arrhythmogenic Substrate ◽  
Ablation Success ◽  
History Of ◽  
Ventricular Activity ◽  
Epicardial Access

Introduction. Radiofrequency ablation (RFA) is an established treatment of post-myocardial infarction ventricular tachycardia (VT). Endocardial VT ablation can be insufficient for VT termination when the scar is intramural/epicardial.Purpose: to assess the extent of epicardial electrophysiological VT substrate in patients with remote myocardial infarction.Materials and methods. Thirteen patients with sustained postinfarction VT, who signed an informed consent, were included into the study. All patients underwent full clinical evaluation. Electroanatomical voltage bi- and unipolar mapping of endocardial and epicardial surfaces was performed. Maps were evaluated for the presence of low-voltage areas and local abnormal ventricular activity (LAVA). RFA was performed at LAVA sites. The end-point of the procedure was scar LAVA abolition and VT noninducibility (procedure success). VT recurrence was detected using an implantable cardioverter-defibrillator and/or ECG monitoring.Results. Epicardial access was successful in 12 patients. Epicardial access was performed at a first procedure in 7 patients, 4 patients had a history of previous endocardial ablation. Epicardial LAVA sites were detected in 9 patients. Endocardial and epicardial arrhythmogenic substrate localization coincided in 8 patients. One patient had only epicardial scar, 1 patient had only septal endocardial scar. In one patient LAVA sites had different localizations on epicardial and endocardial maps. Acute ablation success was noted in 12 patients.Conclusion. In our patient group transmural scar and epicardial electrophysiological arrhythmogenic substrate was detected in 82% of cases. Isolated endocardial ablation may be unsuccessful, in such cases epicardial mapping and ablation might be useful.

Usefulness of epicardial impedance evaluation for epicardial mapping and determination of epicardial ablation site for ventricular tachycardia: A pilot study

2017 ◽  
Vol 29 (1) ◽  
pp. 138-145 ◽  
Author(s):  
Takeshi Kitamura ◽  
Seiji Fukamizu ◽  
Satoshi Miyazawa ◽  
Iwanari Kawamura ◽  
Rintaro Hojo ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Pilot Study ◽  
Epicardial Mapping ◽  
Epicardial Ablation

Epicardial Ablation of Ventricular Tachycardia in Ischemic Cardiomyopathy

2020 ◽  
Vol 12 (3) ◽  
pp. 313-319
Author(s):  
Travis D. Richardson ◽  
Arvindh N. Kanagasundram ◽  
William G. Stevenson
Keyword(s):  
Ventricular Tachycardia ◽  
Ischemic Cardiomyopathy ◽  
Epicardial Ablation

scholarly journals Practical Guide to Ablation for Epicardial Ventricular Tachycardia: When to Get Access, How to Deal with Anticoagulation and How to Prevent Complications

2018 ◽  
Vol 7 (3) ◽  
pp. 159 ◽  
Author(s):  
Ramanan Kumareswaran ◽  
Francis E Marchlinski ◽  
◽  
Keyword(s):  
Patient Safety ◽  
Ventricular Tachycardia ◽  
Best Practices ◽  
Coronary Arteries ◽  
Phrenic Nerve ◽  
High Likelihood ◽  
Epicardial Ablation ◽  
Voltage Mapping ◽  
Systemic Anticoagulation ◽  
Epicardial Access

Epicardial ablation is needed to eliminate ventricular tachycardia (VT) in some patients with nonischaemic cardiomyopathy. The 12-lead electrocardiogram of VT, pre-procedural imaging and endocardial unipolar voltage maps can predict a high likelihood of epicardial substrate and VT. A septal VT substrate may preclude the need for epicardial access and mapping and can be identified with imaging, pacing and voltage mapping. Pericardial access is usually obtained prior to systemic anticoagulation or after reversal of systemic anticoagulation. A unique set of complications can be encountered with epicardial access, mapping and ablation, which include haemopericardium, phrenic nerve injury, damage to major coronary arteries and pericarditis. Anticipating, preventing and, if necessary, managing these complications are paramount for patient safety. Best practices are reviewed.

Endocardial and Epicardial Ablation Guided by Nonsurgical Transthoracic Epicardial Mapping to Treat Recurrent Ventricular Tachycardia

1998 ◽  
Vol 9 (3) ◽  
pp. 229-239 ◽  
Author(s):  
EDUARDO SOSA ◽  
MAURICIO SCANAVACCA ◽  
ANDRE D'AVILA ◽  
JOÃO PICCIONI ◽  
OSVALDO SANCHEZ ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Epicardial Mapping ◽  
Epicardial Ablation
Sign in / Sign up

Export Citation Format

Share Document