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Perfusion. 2019 Mar;34(2):154-163. doi: 10.1177/0267659118814689. Epub 2018 Nov 16.

Open chest epicardial and transapical endocardial substrate ablation for ventricular tachycardia with left ventricular aneurysm in a porcine model.

Li B1,2, Liu C1,2, Wang L1,2, Wang J2,3, Hu Y4, Gu C1,2.

Author information

1
1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
2
2 Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.
3
3 Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
4
4 Department of Cardiology, the First-affiliated Hospital of Henan University of Traditional Chinese Medicine, Henan, China.

Abstract

BACKGROUND:

Endo-epicardial radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) as a first-line strategy has been shown to improve outcomes. This study sought to evaluate the feasibility and validity of open-chest epicardial and transapical endocardial substrate ablation for VT with left ventricular aneurysm (LVA) applying to routine cardiac surgery.

METHODS:

Porcine models of LVA with VT were developed and were divided into a study group (RFCA from the epicardium via direct-view and endocardium via transapical access) and a control group (endocardial RFCA via retrograde transaortic access). Substrate-based mapping and ablation targeting abnormal potentials were performed under thoracotomy. Outcomes, including procedural success and acute freedom from VT, were analysed.

RESULTS:

Twenty-four of 35 (68.57%) acute myocardial infarction (AMI) pigs developed LVA with VT in a 6-week survival period and were randomly divided into a study group (n=12) and a control group (n=12). All animals in the study group successfully underwent endocardial mapping and ablation by transapical access. The scar size of the endocardium and the left ventricular chamber volume were similar in the two groups. Acute freedom from VT in the study group was remarkably superior to that in the control group (88.33% vs. 58.33%, p=0.04).

CONCLUSIONS:

Combined, direct epicardial and transapical endocardial substrate mapping and ablation appeared to be feasible and effective for treating VT with LVA under thoracotomy.

KEYWORDS:

left ventricular aneurysm; open chest; substrate ablation; transapical access; ventricular tachycardia

PMID:
30445894
DOI:
10.1177/0267659118814689
[Indexed for MEDLINE]

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