Open surgical ablation of ventricular tachycardia: Utility and feasibility of contemporary mapping and ablation tools.

Autor:	Kunkel M; University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado., Rothstein P; Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas., Sauer P; Brigham and Women's Hospital, Cardiac Arrhythmia Service, Boston, Massachusetts., Zipse MM; University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado., Sandhu A; University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado.; VA Eastern Colorado Health Care System, Aurora, Colorado., Tumolo AZ; University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado., Borne RT; University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado., Aleong RG; University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado., Cleveland JC Jr; University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado., Fullerton D; University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado., Pal JD; University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado., Davies AS; Abbott, St. Paul, Minnesota., Lane C; Abbott, St. Paul, Minnesota., Nguyen DT; Stanford University, Section of Electrophysiology, Division of Cardiology, Palo Alto, California., Sauer WH; Brigham and Women's Hospital, Cardiac Arrhythmia Service, Boston, Massachusetts., Tzou WS; University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado.
Jazyk:	angličtina
Zdroj:	Heart rhythm O2 [Heart Rhythm O2] 2021 May 11; Vol. 2 (3), pp. 271-279. Date of Electronic Publication: 2021 May 11 (Print Publication: 2021).
DOI:	10.1016/j.hroo.2021.05.004
Abstrakt:	Background: Ventricular tachycardia (VT) catheter ablation success may be limited when transcutaneous epicardial access is contraindicated. Surgical ablation (SurgAbl) is an option, but ablation guidance is limited without simultaneously acquired electrophysiological data. Objective: We describe our SurgAbl experience utilizing contemporary electroanatomic mapping (EAM) among patients with refractory VT storm. Methods: Consecutive patients with recurrent VT despite antiarrhythmic drugs (AADs) and prior ablation, for whom percutaneous epicardial access was contraindicated, underwent open SurgAbl using intraoperative EAM guidance. Results: Eight patients were included, among whom mean age was 63 ± 5 years, all were male, mean left ventricular ejection fraction was 39% ± 12%, and 2 (25%) had ischemic cardiomyopathy. Reasons for surgical epicardial access included dense adhesions owing to prior cardiac surgery, hemopericardium, or pericarditis (n = 6); or planned left ventricular assist device (LVAD) implantation at time of SurgAbl (n = 2). Cryoablation guided by real-time EAM was performed in all. Goals of clinical VT noninducibility or core isolation were achieved in 100%. VT burden was significantly reduced, from median 15 to 0 events in the month pre- and post-SurgAbl ( P  = .01). One patient underwent orthotopic heart transplantation for recurrent VT storm 2 weeks post-SurgAbl. Over mean follow-up of 3.4 ± 1.7 years, VT storm-free survival was achieved in 6 (75%); all continued AADs, although at lower dose. Conclusion: Surgical mapping and ablation of refractory VT with use of contemporary EAM is feasible and effective, particularly among patients with contraindication to percutaneous epicardial access or with another indication for cardiac surgery. (© 2021 Heart Rhythm Society. Published by Elsevier Inc.)
Databáze:	MEDLINE
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