title: Percutaneous epicardial radiofrequency ablation of ventricular arrhythmias after failure of endocardial approach: a 9-year experience.
abstract: BACKGROUND
  Management of recurrent ventricular tachycardia (VT) remains difficult. Neither medical treatments nor conventional endocardial radiofrequency (RF) ablation are efficient to prevent some recurrences. In these cases, a percutaneous pericardial approach may be required.
  
  
  METHODS
  Among all the patients referred to our center between 1998 and 2007 for a VT ablation, 276 endocardial and 35 epicardial procedures were performed, the latter in case of failure of the conventional approach. We report in this study the efficacy and the safety of these 35 interventions analyzed retrospectively.
  
  
  RESULTS
  Thirty-five epicardial procedures were attempted in 32 patients. An electric storm was present in 5 of 32 (16%) patients, with other individuals presenting with a recurrent VT despite drug therapy and a previous endocardial ablation. Pericardial space was reached in 28 of 32 patients by a xyphoidian puncture. An immediate success of RF on clinical VT was obtained in 22 of 29 (76%) cases. During a mean follow-up of 384 +/- 405 days, only 9 patients (26%) experienced a recurrence of a sustained VT. One patient died from tamponade during the procedure despite surgical drainage. Other complications had no significant consequences.
  
  
  CONCLUSIONS
  Percutaneous epicardial puncture is feasible and relatively safe in patients with recurrent VT in whom conventional endocardial RF ablation failed. Epicardial RF ablation offers a high success rate in these challenging patients with only few severe complications.
authors: Institut de Cardiologie, hôpital Pitié-Salpétrière, Paris, France. caroline.grimard@univ-tours.fr
authors: Caroline
authors: C
authors: Grimard
authors: Jérôme
authors: J
authors: Lacotte
authors: Françoise
authors: F
authors: Hidden-Lucet
authors: Guillaume
authors: G
authors: Duthoit
authors: Yves
authors: Y
authors: Gallais
authors: Robert
authors: R
authors: Frank
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000379:methods*; D062109:Dermatologic Surgical Procedures; D004699:Endocardium / Q000601:surgery*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011677:Punctures / Q000379:methods*; D012086:Reoperation; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000601:surgery*; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult