title: Long-term outcomes of combined epicardial and endocardial ablation of monomorphic ventricular tachycardia related to hypertrophic cardiomyopathy.
abstract: BACKGROUND
  Monomorphic ventricular tachycardia (MMVT) is rare in patients with hypertrophic cardiomyopathy (HCM). There are limited data on the utility of catheter ablation for the treatment of MMVT in this population. This study details a series of case reports from multiple centers where combined epicardial-endocardial ablation was performed in a highly selected group of patients with HCM-related MMVT.
  
  
  RESULTS
  The cohort consisted of 10 patients with HCM-related MMVT. Pericardial access was achieved using the percutaneous subxyphoid approach. Epicardial and endocardial ventricular 3D bipolar voltage maps were generated. Ablation sites were identified using a combination of entrainment, activation, late/fractionated potential, and pace mapping. Electrophysiological-identified epicardial scar was present in 8 (80%) patients, endocardial scar in 6 (60%), and no scar in 1 (10%). In the 5 patients with inducible, stable MMVT, 3 cases were successfully terminated with ablation from the epicardium and 1 from the endocardium. The case that failed catheter ablation required surgical cryoablation to abolish the incessant VT. In the remaining 5 patients, 4 underwent epicardial and endocardial ablation of sites with good pace maps and late/fractionated potentials. No ablation was performed in the remaining patient because of noninducibility and lack of identifiable scar. After 37±17 months (limits, 2 to 62 months; median, 37 months), the freedom from recurrent implantable cardioverter-defibrillator shocks was 78% (7/9 patients) in those who underwent ablation.
  
  
  CONCLUSIONS
  In highly selected patients with HCM, combined epicardial and endocardial mapping and ablation is a feasible and reasonably efficacious option for MMVT if refractory to aggressive trials of antiarrhythmic drugs and antitachycardia pacing.
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Srinivas R
authors.initials: SR
authors.lastname: Dukkipati
authors.forename: Andre
authors.initials: A
authors.lastname: d'Avila
authors.forename: Kyoko
authors.initials: K
authors.lastname: Soejima
authors.forename: Rupa
authors.initials: R
authors.lastname: Bala
authors.forename: Keiichi
authors.initials: K
authors.lastname: Inada
authors.forename: Sheldon
authors.initials: S
authors.lastname: Singh
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
authors.forename: Vivek Y
authors.initials: VY
authors.lastname: Reddy
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000503:physiopathology; D017115:Catheter Ablation / Q000379:methods*; D003452:Cryosurgery; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation; D022062:Electrophysiologic Techniques, Cardiac; D004699:Endocardium / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007564:Japan; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000889:Anti-Arrhythmia Agents