Abstract
BackgroundEpicardial access for Ventricular Arrhythmia (VA) ablation is a challenging and relatively uncommon procedure during ventricular ablation. ObjectiveThis study aims to assess the outcomes, predictors of success, and complications associated with pericardial access during these procedures. MethodsThis multicenter, retrospective, observational study includes data collected over twenty years (2004–2024) from all Mayo Clinic sites performing VA ablation with epicardial access. ResultsWith 196 for VT and 69 for PVC ablations respectively A total of 265 patients were included in the analysis: 196 for VT ablation and 69 for PVC ablation. Among them, 184(69%) had at least one previous VA ablation, 51 (19.2%) had ischemic cardiomyopathy (ICM), 53(20%) had structurally normal hearts, and 164 (61.9%) had nonischemic cardiomyopathies (NICM). Three presented with concomitant ICM and NICM. Within the NICM group, the most common diagnoses were dilated cardiomyopathy (n=80, 30.2%), arrhythmogenic right ventricular cardiomyopathy (n=34, 12.8%), and sarcoidosis (n=15, 5.7%).Acute success, defined as noninducibility, was achieved in 100 (61.7%) out of 162 patients tested, while partial success (clinical arrhythmia noninduciblility) was observed in 47(29%). Before discharge, VT recurred in 20 patients (10.2%).During a median follow-up of 61 months, events were observed as follows:, 60 patients (35.5%) died, 26(13.3%) underwent heart transplantation, and 62 (31.6%) required a repeat ablation for VAs. Event-free survival rates were 50% (CI: 43-58%) at one year. ConclusionsSuccessful VT ablation with Epicardial access can be achieved in select cases, though event-free survival remains suboptimal. Advanced disease stage and persistent inducibility at the end of the procedure are predictors of poor outcomes.
Published Version
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