Nonsurgical transthoracic epicardial radiofrequency ablation: an alternative in incessant ventricular tachycardia.
OBJECTIVE
The purpose of this study was to analyze the feasibility, efficacy, and safety of epicardial radiofrequency (RF) ablation in patients with incessant ventricular tachycardia (VT).


BACKGROUND
Management of patients with incessant VT is a difficult clinical problem. Drugs and RF catheter ablation are not always effective. A nonsurgical transthoracic epicardial RF ablation can be an alternative in patients refractory to conventional therapy.


METHODS
Epicardial RF ablation was performed in 10 patients who presented with incessant VT despite the use of two or more intravenous antiarrhythmic drugs.


RESULTS
In eight patients, endocardial ablation (EdA) failed to control the tachycardia. In the remaining two patients, epicardial ablation (EpA) was first attempted because of left ventricular thrombus and severe artery disease, respectively. Eight patients had a diagnosis of coronary artery disease with healed myocardial infarction. One patient had dilated cardiomyopathy, and one patient had idiopathic, incessant VT. In patients with structural heart disease, the mean ejection fraction was 0.28 +/- 0.10%. Four patients previously received an implantable defibrillator. The EpA effectively terminated the incessant tachycardia in eight patients, which represents a success rate of 80%. In them, after a follow-up of 18 +/- 18 months, a single episode of a different VT was documented in one patient. No significant complications occurred related to the procedure.


CONCLUSIONS
In patients with incessant VT despite the use of drugs or standard EdA, the epicardial approach was very effective and should be considered as an alternative in this life-threatening situation.
Brugada
Josep
J
Arrhythmia Section, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Villaroel 170, 08036 Barcelona, Spain. jbrugada@clinic.ub.es
Berruezo
Antonio
A
Cuesta
Alejandro
A
Osca
Joaquin
J
Chueca
Enrique
E
Fosch
Xavier
X
Wayar
Luis
L
Mont
Lluis
L
D000368:Aged; D002037:Bundle-Branch Block / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D017115:Catheter Ablation; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012008:Recurrence; D013318:Stroke Volume / Q000502:physiology; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D013995:Time; D016896:Treatment Outcome