title: Epicardial ablation for ventricular tachycardia: a European multicenter study.
abstract: BACKGROUND
  The purpose of this study was to describe the epicardial percutaneous ablation experience of 6 European high-volume ventricular tachycardia (VT) ablation centers.
  
  
  RESULTS
  Data from 218 patients with coronary artery disease (CAD, n=85 [39.0%]), idiopathic dilated of patients with idiopathic VT cardiomyopathy (IDCM, n=67 [30.7%]), arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARCD/C, n=13 [6%]), hypertrophic cardiomyopathy (HCM, n=5 [2.3%]), and absence of structural heart disease (n=48 [22%]) undergoing epicardial subxyphoid access for VT ablation were collected. The epicardial approach was attempted as first-line treatment in 78 patients (35.8%). Acute prevention of VT inducibility was obtained in 156 patients (71.6%). There were no procedure-related deaths. Cardiac tamponade occurred in 8 patients, and abdominal hemorrhage in 1 patient. Six patients died of electrical storm recurrence within 48 hours from the procedure. After a mean follow-up of 17.3±18.2 months, 60 patients (31.4%) presented with VT recurrence (39.3% of IDCM patients; 34.7% of CAD patients; 30.8% of ARVD/C patients; 25% of HCM patients; 17.1% of patients with idiopathic VT). Twenty patients (10.4%) died during follow-up (12 of heart failure, 2 of cardiac arrest, and 6 of extracardiac causes).
  
  
  CONCLUSIONS
  In experienced centers, epicardial ablation of VT has an acceptable risk and favorable outcome. In selected patients, it is reasonable to consider as a first-line ablation approach.
authors.affiliation: Arrhythmia Unit and Electrophysiology Laboratory, Ospedale S Raffaele, Milano, Italy. dellabella.paolo@hsr.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Della Bella
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.forename: Katja
authors.initials: K
authors.lastname: Zeppenfeld
authors.forename: Jose
authors.initials: J
authors.lastname: Merino
authors.forename: Petr
authors.initials: P
authors.lastname: Neuzil
authors.forename: Philippe
authors.initials: P
authors.lastname: Maury
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Maccabelli
authors.forename: Pasquale
authors.initials: P
authors.lastname: Vergara
authors.forename: Francesca
authors.initials: F
authors.lastname: Baratto
authors.forename: Antonio
authors.initials: A
authors.lastname: Berruezo
authors.forename: Adrianus P
authors.initials: AP
authors.lastname: Wijnmaalen
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D004562:Electrocardiography; D005060:Europe / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome