title: Epicardial ventricular tachycardia ablation a multicenter safety study.
abstract: OBJECTIVE
  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 cm(3)) 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.
authors.affiliation: Université Bordeaux II, Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France. frederic.sacher@chu-bordeaux.fr
authors.forename: Frédéric
authors.initials: F
authors.lastname: Sacher
authors.forename: Kurt
authors.initials: K
authors.lastname: Roberts-Thomson
authors.forename: Philippe
authors.initials: P
authors.lastname: Maury
authors.forename: Usha
authors.initials: U
authors.lastname: Tedrow
authors.forename: Isabelle
authors.initials: I
authors.lastname: Nault
authors.forename: Daniel
authors.initials: D
authors.lastname: Steven
authors.forename: Meleze
authors.initials: M
authors.lastname: Hocini
authors.forename: Bruce
authors.initials: B
authors.lastname: Koplan
authors.forename: Lionel
authors.initials: L
authors.lastname: Leroux
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.forename: Jens
authors.initials: J
authors.lastname: Seiler
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Wright
authors.forename: Laurence
authors.initials: L
authors.lastname: Epstein
authors.forename: Michel
authors.initials: M
authors.lastname: Haissaguerre
authors.forename: Pierre
authors.initials: P
authors.lastname: Jais
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
mesh_terms: D000328:Adult; D000368:Aged; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000150:complications; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods*; D015331:Cohort Studies; D004562:Electrocardiography; D056149:Epicardial Mapping / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D017751:Safety Management; D012720:Severity of Illness Index; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome