Epicardial Ventricular Tachycardia Ablation: Clinical Practice and Recent Developments

REVIEW, July 2011, VOL I ISSUE IV, ISSN 2042-4884
10.5083/ejcm.20424884.48 , Cite or Link Using DOI
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Michalis Efremidis, George Kollias

INTRODUCTION

Mapping and radiofrequency (RF) catheter ablation of ventricular tachycardia (VT) is a demanding procedure, with variable success rates. The presence of deep subendocardial or epicardial re-entry circuits is regarded as one of the reasons of failure of endocardial ablation, and these circuits have been acknowledged in ischemic and non-ischemic dilated cardiomyopathy (CMP), other types of CMP and especially in arrhythmogenic right ventricular cardiomyopathy (ARVC).

The significance of epicardial VT circuits was brought to light in Chagas’ disease, which characteristically results in epicardial involvement in approximately 70% of patients. A recent study found one third of VTs to be epicardial in origin among patients with nonischemic CMP, about double the incidence among those with ischemic heart disease. Mapping and ablation of these epicardial circuits is quite exigent. Although coronary veins can be used to perform epicardial mapping, the manipulation of the catheter is strictly limited to the anatomical distribution of these vessels. Thus, the subxiphoid percutaneous approach to the pericardial space is the only technique that allows extensive, unhampered mapping of the epicardial surface of both ventricles.