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J Am Coll Cardiol. 2014 Apr 15;63(14):1416-26. doi: 10.1016/j.jacc.2013.10.087. Epub 2014 Jan 30.

Endocardial ablation to eliminate epicardial arrhythmia substrate in scar-related ventricular tachycardia.

Author information

1
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France. Electronic address: yk.komat@gmail.com.
2
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.

Abstract

OBJECTIVES:

We evaluated the feasibility and safety of epicardial substrate elimination with endocardial radiofrequency (RF) delivery in patients with scar-related ventricular tachycardia (VT).

BACKGROUND:

Epicardial RF delivery is limited by fat or associated with bleeding, extra-cardiac damages, coronary vessels and phrenic nerve injury. Alternative ablation approaches might be desirable.

METHODS:

Forty-six patients (18 ischemic cardiomyopathy [ICM], 13 nonischemic dilated cardiomyopathy [NICM], 15 arrhythmogenic right ventricular cardiomyopathy [ARVC]) with sustained VT underwent combined endo- and epicardial mapping. All patients received endocardial ablation targeting local abnormal ventricular activities in the endocardium (Endo-LAVA) and epicardium (Epi-LAVA), followed by epicardial ablation if needed.

RESULTS:

From a total of 173 endocardial ablations targeting Epi-LAVA at the facing site, 48 (28%) applications (ICM: 20 of 71 [28%], NICM: 3 of 39 [8%], ARVC: 25 of 63 [40%]) successfully eliminated the Epi-LAVA. Presence of Endo-LAVA, the most delayed and low bipolar amplitude of Epi-LAVA, low unipolar amplitude in the facing endocardium, and Epi-LAVA within a wall thinning area at computed tomography scan were associated with successful ablation. Endocardial ablation could abolish all Epi-LAVA in 4 ICM and 2 ARVC patients, whereas all patients with NICM required epicardial ablation. Endocardial ablation was able to eliminate Epi-LAVA at least partially in 15 (83%) ICM, 2 (13%) NICM, and 11 (73%) ARVC patients, contributing to a potential reduction in epicardial RF applications. Pericardial bleeding occurred in 4 patients with epicardial ablation.

CONCLUSIONS:

Elimination of Epi-LAVA with endocardial RF delivery is feasible and might be used first to reduce the risk of epicardial ablation.

KEYWORDS:

ablation; arrhythmia; epicardium; local abnormal ventricular activities; ventricular tachycardia

PMID:
24486269
DOI:
10.1016/j.jacc.2013.10.087
[Indexed for MEDLINE]
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