Abstract

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.

Highlights

  • The pericardium is a two-layer membrane surrounding the heart and vital vessels

  • In 1996, Sosa et al first described the use of pericardial puncture in an electrophysiological laboratory for epicardial ablation in ventricular arrhythmia, [2] the use of pericardial puncture to map and ablate ventricular arrhythmia started to expand in other diseases [3]

  • Since Sosa et al first introduced the application of epicardial ablation for the ventricular arrhythmias (VAs) in Chagas disease, [2] the use of this technique through a percutaneous method has been applied to other diseases [3]

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Summary

Introduction

The pericardium is a two-layer membrane surrounding the heart and vital vessels. Since Sosa et al first introduced the application of epicardial ablation for the ventricular arrhythmias (VAs) in Chagas disease, [2] the use of this technique through a percutaneous method has been applied to other diseases [3]. An approach with combined endo-epicardial mapping/ablation has been reported to show a better outcome selected patients with non-ischemic cardiomyopathy (NICM) VT ischemic VT [7–10]. The percutaneous technique for epicardial access have been proven to improve outcomes with an acceptable risk of peri-operative adverse event in experienced operator or high-volume centers [11]. Prior studies have reported the incidence rate of major complications around 4.1-8.8%, including adverse event of a hemopericardium, intra-abdominal bleeding, and arterial/venous/nerve injuries [11–14]. This chapter was aimed to discuss the clinical implication, patient selection, and detailed procedure for the epicardial ablation in the patients with VA

Contraindication for endocardial approach
Contraindication for percutaneous epicardial approach
Myocardial infarction related VT
Idiopathic ventricular arrhythmia
Brugada syndrome catheter ablation
Non-ischemic cardiomyopathy
When should be considered to perform the epicardial approach?
Traditional method (posterior approach)
Needle-in-needle method A ‘needle-in-needle’ technique for epicardial access has been described by
Surgical access
Periprocedural complications of an epicardial approach
Patients with anticoagulant
Findings
Conclusion
Full Text
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