Abstract
Objective: Epicardial access is sometimes required to effectively treat ventricular arrhythmias, but it can be associated with increased risk of procedural complications needing surgical intervention. The present study aimed to evaluate the feasibility and safety of epicardial mapping/ablation in experienced center without onsite cardiac surgery.Methods: Patients who had drug-refractory, recurrent ventricular arrhythmias were scheduled for catheter ablation. All operators (SC, JC, SB, BS) had at least fifty pericardial puncture experiences. Epicardial puncture and perioperative anticoagulation were carried out based on institutional protocol. Phrenic nerve was mapped by 3-D mapping system. Coronary anatomy was delineated by coronary angiography.Results: A total of 44 patients (63.3 years, male 86.4%) received epicardial access. Of them 7 (15.9%) were scheduled for PVC ablation, 37 (84.1%) for VT ablation (ICM: 25%, NICM: 59.1%). Mean LVEF was 41.3%. Acute ablation success rate was 35 (79.5%). Procedural adverse events included: pericardial effusion occurred in 3 (6.8%) patients who all well treated with pericardial drainage; and pericardial tamponade in 1 (2.3%) patient requiring transfer to surgical intervention. No death, stroke, phrenic nerves palsy, or coronary artery injury were observed. Median hospitalization was 4 (3–6) days. Univariable analysis and ROC curve showed that patients’ age was a significant predictor of epicardial procedural complication (area under curve (AUC): 0.813, P = 0.041).Conclusions: Guided by a tailored procedural protocol, the majority of the epicardial access related complications can be treated conservatively without needing onsite surgery. Older age is a risk factor associated with epicardial access related complications.
Highlights
Ventricular arrhythmias (VA), ventricular tachycardia (VT), is one of the most challenging medical conditions
Considering that the epicardial access related complications are preventable, and the majority of the complications can be managed conservatively, we hypothesized that it is feasible to carry out epicardial mapping/ablation for indicated patients without onsite surgical support in experienced centers
Management of ventricular arrhythmias ventricular tachycardia represents a challenge in clinical practice
Summary
Ventricular arrhythmias (VA), ventricular tachycardia (VT), is one of the most challenging medical conditions. Antiarrhythmic drugs (AADs) usually have limited effectiveness and are poorly tolerated.[1,2] Catheter ablation has been increasingly utilized to better treat patients with VAs. The majority of the ablations are performed endocardially, while epicardial mapping and ablation is sometimes required.[3,4]. Access to the pericardial space is usually achieved by the percutaneous approach described by Sosa et al,[5] and the major risk of pericardial access is pericardial bleeding.[6,7] Because of these important complications, current international guidelines[8] recommend onsite surgical support. Considering that the epicardial access related complications are preventable, and the majority of the complications can be managed conservatively, we hypothesized that it is feasible to carry out epicardial mapping/ablation for indicated patients without onsite surgical support in experienced centers
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