Author + information
- Received July 4, 2009
- Revision received October 2, 2009
- Accepted October 18, 2009
- Published online May 25, 2010.
- Frédéric Sacher, MD⁎,†,⁎ (, )
- Kurt Roberts-Thomson, MBBS, PhD†,
- Philippe Maury, MD‡,
- Usha Tedrow, MD†,
- Isabelle Nault, MD⁎,
- Daniel Steven, MD†,
- Meleze Hocini, MD⁎,
- Bruce Koplan, MD†,
- Lionel Leroux, MD⁎,
- Nicolas Derval, MD⁎,
- Jens Seiler, MD†,
- Matthew J. Wright, MBBS, PhD⁎,
- Laurence Epstein, MD†,
- Michel Haissaguerre, MD⁎,
- Pierre Jais, MD⁎ and
- William G. Stevenson, MD†
- ↵⁎Reprint requests and correspondence:
Dr. Frédéric Sacher, Hôpital Cardiologique du Haut-Lévêque, 33604 Bordeaux-Pessac, France
Objectives The aim of this study was to perform a systematic evaluation of safety and midterm complications after epicardial ventricular tachycardia (VT) ablation.
Background Epicardial VT ablation is increasingly performed, but there is limited information about its safety and midterm complications.
Methods All patients undergoing VT ablation at 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 men; mean age 56 ± 15 years) after a previous VT ablation in 115 (86%). The underlying substrates were ischemic cardiomyopathy in 51 patients, nonischemic cardiomyopathy in 39 patients, arrhythmogenic right ventricular cardiomyopathy in 14 patients, and other types of cardiomyopathy in 30 patients.
Results Epicardial access was obtained via percutaneous subxiphoid puncture in 136 procedures, by a surgical subxiphoid approach in 14, and during open-heart surgery in 6. Epicardial ablation (mean radiofrequency duration: 13 ± 12 min; median: 10 min) was performed in 121 of 156 procedures (78%). Twenty patients subsequently required repeat procedures, and the epicardium could be reaccessed in all but 1 patient. A total of 8 (5%) major complications related to pericardial access were observed acutely: 7 epicardial bleeding (>80 cm3) and 1 coronary stenosis. After a mean follow-up period of 23 ± 21 months, 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.
Conclusions VT ablation required epicardial ablation in 121 of 913 procedures (13%), with a risk of 5% and 2% of acute and delayed major complications related to epicardial access.
Dr. Sacher received an unrestricted research grant from the French Federation of Cardiology. Dr. Roberts-Thomson is the recipient of a Postgraduate Research Scholarship (grant ID 489417) from the National Health and Medical Research Council of Australiaand the AstraZeneca Fellowship in Medical Research from the Royal Australian College of Physicians. Dr. Tedrow has received research grants from Biosense Websterand Boston Scientificand speaking honoraria from Medtronic and Boston Scientific. Dr. Seiler has received a research grant from St. Jude Medical. Dr. Epstein has received honoraria for speaking, research, and consulting from Boston Scientific, Medtronic, and St. Jude Medical. Dr. Haissaguerre has received consulting fees from Biosense Webster. Dr. Jais has received honoraria for speaking, research, and consulting from Biosense Webster and St. Jude Medical.
- Received July 4, 2009.
- Revision received October 2, 2009.
- Accepted October 18, 2009.
- American College of Cardiology Foundation