title: Repeat percutaneous epicardial mapping and ablation of ventricular tachycardia: safety and outcome.
abstract: BACKGROUND
  Epicardial mapping and ablation of ventricular tachycardia (VT) has been increasingly performed. Occasionally additional ablation is necessary, requiring repeat percutaneous access to the pericardial space.
  
  
  RESULTS
  We studied 30 consecutive patients who required a repeat epicardial procedure. We specifically examined the success and safety of repeat percutaneous pericardial access as well as the ability to map and ablate epicardial VT targets. Percutaneous pericardial access at a median of 110 days after the last procedure was successful in all 30 patients. Significant adhesions interfering with catheter mapping were encountered in 7 patients (23%); 6 had received intrapericardial triamcinolone acetate (IPTA) with prior procedures. Using blunt dissection with a deflected ablation catheter and a steerable sheath, adhesions were divided allowing for complete catheter mapping in 5 patients with areas of dense adherence compartmentalizing the pericardium in 1 patient and precluding ablation over previously targeted ablation site in the second. Targeted VT noninducibility was achieved in 27 (90%) patients including 7 patients with adhesions. No direct complications related to pericardial access or adhesions disruption occurred. One periprocedural death occurred from refractory cardiogenic shock in patient with LV ejection fraction of 10%. Another patient developed asymptomatic positive Haemophilus influenzae pericardial fluid cultures identified at second procedure, which was successfully treated.
  
  
  CONCLUSIONS
  Repeat access can be obtained after prior epicardial ablation. Adhesions from prior procedures may limit mapping, but can usually be disrupted mechanically and allow for ablation of recurrent VT. IPTA may not completely prevent adhesions.
authors.affiliation: Cardiac Electrophysiology Program, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Cory M
authors.initials: CM
authors.lastname: Tschabrunn
authors.forename: Haris M
authors.initials: HM
authors.lastname: Haqqani
authors.forename: Erica S
authors.initials: ES
authors.lastname: Zado
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation; D057785:Catheters; D004562:Electrocardiography; D004867:Equipment Design; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D015143:Philadelphia; D011237:Predictive Value of Tests; D011859:Radiography; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D000267:Tissue Adhesions; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage / Q000031:analogs & derivatives; D056969:Voltage-Sensitive Dye Imaging
chemical_list: D014221:Triamcinolone