Author + information
- Rhanderson Cardosoa,b,
- Gilson Fernandesa,b,
- Guilherme Nasia,b,
- Joao Braghirolia,b and
- Andre D'Avilaa,b
Background: The efficacy of conventional endocardial catheter ablation for ventricular tachycardia (VT) is limited in a significant proportion of cases by the subepicardial location of scar. Traditionally, percutaneous epicardial mapping and ablation are reserved for patients in whom endocardial ablation has failed.
Methods: We performed a systematic review and meta-analysis comparing a combined endo-epicardial strategy for first VT ablations to the traditional stepwise endocardial-first approach. PubMed, EMBASE, and Cochrane Central were searched.
Results: Four studies and 267 patients were included, of whom 94 (35%) were in the endo-epicardial group. The majority were men (85%) with ischemic substrates (87%). Inducible VT after ablation was not significantly different between both groups (p=0.43). There was a trend towards increased cardiac tamponade in the endo-epicardial group (5% vs. 0.8%; OR 6.3; p=0.07). Groin hematoma, phrenic nerve palsy, and strokes were not significantly different between groups. During 1-3 year follow-up, mortality was not different between groups (p=0.16). However, VT recurrence (Fig. 1) and repeat ablations (OR 0.22; 95% CI 0.09-0.55; p<0.01) were significantly lower in the endo-epicardial group.
Conclusions: These results suggest improved freedom from VT in intermediate-term follow-up with an initial endo-epicardial approach as compared to the standard stepwise endocardial-first ablation. Randomized studies are warranted to confirm these findings.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Innovative Approaches for Reducing Risk and Improving Outcomes With Ablation
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1237-104
- 2017 American College of Cardiology Foundation