Road-Map to Epicardial Approach for Catheter Ablation of Ventricular Tachycardia in Structural Heart Disease: Results From a 10-Year Tertiary-Center Experience.

Autor:	Bisceglia C; Arrhythmia Unit and EP laboratories, San Raffaele Hospital, Milan, Italy., Limite LR; Arrhythmia Unit and EP laboratories, San Raffaele Hospital, Milan, Italy., Baratto F; Arrhythmia Unit and EP laboratories, San Raffaele Hospital, Milan, Italy., D'Angelo G; Arrhythmia Unit and EP laboratories, San Raffaele Hospital, Milan, Italy., Cireddu M; Arrhythmia Unit and EP laboratories, San Raffaele Hospital, Milan, Italy., Della Bella P; Arrhythmia Unit and EP laboratories, San Raffaele Hospital, Milan, Italy.
Jazyk:	angličtina
Zdroj:	Circulation. Arrhythmia and electrophysiology [Circ Arrhythm Electrophysiol] 2024 Jul; Vol. 17 (7), pp. e012181. Date of Electronic Publication: 2024 Jun 05.
DOI:	10.1161/CIRCEP.123.012181
Abstrakt:	Background: Epicardial approach in ventricular tachycardia (VT) ablation is still regarded as a second-step strategy, due to the risk of complications. We evaluated the frequency that epicardial ablation targets were identified and ablation performed following pericardial access compared with unnecessary pericardial access for different VT causes and potential markers of epicardial VT. Methods: All VT ablation procedures including epicardial approach over a 10-year period were included. First-line epicardial approach was indicated in arrhythmogenic right ventricular cardiomyopathy (ARVC) and postmyocarditis VT; in patients with idiopathic dilated cardiomyopathy (IDCM) and postmyocardial infarction, indications resulted from available imaging techniques or 12-lead VT morphology. The epicardial approach was considered useful if epicardial ablation was performed after epicardial mapping. Feasibility, complications, and long-term outcome were reported. Results: Four hundred and eighty-eight subjects with a median age of 60 years (interquartile range, 47-65) and of left ventricle ejection fraction 41% (interquartile range, 30-55) underwent 626 epicardial VT ablations. Percutaneous access had a success rate of 92.2% and a complication rate of 3.6%. Overall, epicardial approach was, respectively, indicated to 11.8% of postmyocardial infarction patients, 49.5% in IDCM, 94% in myocarditis, and 90.7% in ARVC. Epicardial ablation at the first ablation attempt was performed in 9.3% of postmyocardial infarction patients, 28.8% in IDCM, 86.5% in myocarditis, and 81.3% in patients with ARVC. In first-line epicardial group, ARVC and myocarditis showed the highest odds for epicardial ablation (OR, 4.057 [95% CI, 1.299-8.937]; P =0.007; OR, 3.971 [95% CI, 1.376-11.465]; P =0.005, respectively). IDCM independently predicted unnecessary epicardial approach (OR, 2.7 [95% CI, 1.7-4.3]; P <0.001). After a follow-up of 41 months (interquartile range, 19-64), patients with IDCM experienced higher rate of recurrences and mortality compared with other causes. Conclusions: Epicardial approach is integral part of ablation armamentarium regardless of the VT cause, with high feasibility and low complication rate in experienced centers. Our data support its use at first ablation attempt in VTs related to ARVC and myocarditis. Competing Interests: Drs Bisceglia and Della Bella report consultant fees from Boston Scientific, Abbott, and Biosense Webster. The other authors report no conflicts.
Databáze:	MEDLINE
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