Percutaneous pericardial instrumentation for endo-epicardial mapping of previously failed ablations
| Autor: | Dianna Bash, Walid Saliba, Salwa Beheiry, Thomas Dresing, Andrea Natale, Logan Kanagaratnam, Robert A. Schweikert, Nassir F. Marrouche, Patrick J. Tchou, Cathy Lam, Gery Tomassoni, Christopher R. Cole |
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| Rok vydání: | 2003 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Catheter ablation Accessory pathway Ventricular tachycardia Physiology (medical) Internal medicine Atrial Fibrillation Medicine Pericardium Humans cardiovascular diseases Treatment Failure Idiopathic Cardiomyopathy Aged Ischemic cardiomyopathy business.industry Body Surface Potential Mapping Arrhythmias Cardiac Middle Aged medicine.disease Ablation Inappropriate sinus tachycardia Tachycardia Sinus medicine.anatomical_structure Treatment Outcome Cardiology Catheter Ablation Tachycardia Ventricular Female Cardiology and Cardiovascular Medicine business Endocardium Follow-Up Studies |
| Zdroj: | Circulation. 108(11) |
| ISSN: | 1524-4539 |
| Popis: | Background— The epicardial location of an arrhythmia could be responsible for unsuccessful endocardial catheter ablation. Methods and Results— In 48 patients referred after prior unsuccessful endocardial ablation, we considered percutaneous, subxiphoid instrumentation of the pericardial space for mapping and ablation. Thirty patients had ventricular tachycardia (VT), 6 patients had a right- and 4 had a left-sided accessory pathway (AP), 4 patients had inappropriate sinus tachycardia, and 4 patients had atrial arrhythmias. Of the 30 VTs, 24 (6 with ischemic cardiomyopathy, 3 with idiopathic cardiomyopathy, and 15 with normal hearts) appeared to originate from the epicardium. Seventeen (71%) of these 24 VTs were successfully ablated with epicardial lesions. The other 7 VTs had early epicardial sites that were inaccessible, predominantly because of interference from the left atrial appendage. Six of these were successfully ablated from the left coronary cusp. In 5 of the 10 patients with an AP, the earliest activation was recorded epicardially. Three of these were right atrial appendage–to–right ventricle APs, and epicardial ablation was successful. No significant complications were observed. Conclusions— Failure of endocardial ablation could reflect the presence of an epicardial arrhythmia substrate. Epicardial instrumentation and ablation appeared feasible and safe and provided an alternative strategy for the treatment of patients with a variety of arrhythmias. This was particularly true for VT, including patients without structural heart disease. |
| Databáze: | OpenAIRE |
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