229 Epicardial VT Ablation: A Multicentre Safety Study

IntroductionAlthough most ventricular tachycardia (VT) originates from the endocardium, epicardial substrate requiring epicardial mapping/ablation is increasingly recognized. There is, however, limited information about its safety and mid-term complications.MethodsAll patients undergoing VT ablation in 3 tertiary care centers between 2001 and 2007 were included in this study. Of 913 VT ablations, 156 procedures (17%) involved epicardial mapping and/or ablation. These were performed in 134 patients (109 male, 56 ±15yo), after a previous VT ablation in 119 (76%). The underlying substrate was ischemic cardiomyopathy (CMP) in 51, non ischemic CMP in 39, Arrhythmogenic Right Ventricular Cardiomyopathy in 13, and others types of CMPs in 31.ResultsEpicardial access was obtained via percutaneous subxyphoid puncture in 136 procedures, by a surgical subxyphoid approach in 14 and during open heart surgery in 6. Epicardial ablation (13±12min; median: 10min) was performed in 121/156 procedures (78%). Nineteen patients subsequently required repeat procedure(s) and the epicardium could be re-accessed in all but one patient.A total of 8/156 (5%) major complications related to pericardial access were observed acutely: 7 epicardial bleeding (>100cc) [all bleeding stopped spontaneously] and 1 coronary stenosis.After a mean follow-up of 23±21months, 3 delayed complications related to pericardial access, were noted (1 major pericardial inflammatory reaction, 1 delayed tamponade and 1 coronary occlusion 2 weeks after the procedure).ConclusionVT ablation requires epicardial mapping and ablation in 121/913 (13%) procedures with a risk of 5% and 2% of acute and delayed major complications related to epicardial access