title: Epicardial ablation of ventricular tachycardia: an institutional experience of safety and efficacy.
abstract: BACKGROUND
  Epicardial ablation has been shown to be a useful adjunct for treatment of ventricular tachycardia (VT).
  
  
  OBJECTIVE
  To report the trends, safety, and efficacy of epicardial mapping and ablation at a single center over an 8-year period.
  
  
  METHODS
  Patients referred for VT ablation (June 2004 to July 2011) were divided into 3 groups: ischemic cardiomyopathy (ICM), nonischemic cardiomyopathy (NICM), and idiopathic ventricular arrhythmias (VA). Patients with scar-mediated VT who underwent combined epicardial and endocardial (epi-endo) mapping and ablation were compared with those who underwent endocardial-only (endo-only) ablation with regard to patient characteristics, acute procedural success, 6- and 12-month clinical outcomes.
  
  
  RESULTS
  Among 144 patients referred for VT ablation, 95 patients underwent 109 epicardial procedures (94% access rate). Major complications were seen in 8 patients (8.8%) with pericardial bleeding (>80 cm(3)) in 6 cases (6.7%), although no tamponade, surgical intervention, or procedural mortality was seen. Patients with ICM who underwent a combined epi-endo ablation had improved freedom from VT compared with those who underwent endo-only ablation at 12 months (85% vs 56%; P = .03). In patients with NICM, no differences were seen between those who underwent epi-endo ablation and those who underwent endo-only ablation at 12 months (36% vs 33%; P = 1.0). In idiopathic VA, only 2 of 17 patients were successfully ablated from the epicardium.
  
  
  CONCLUSIONS
  In this large tertiary single-center experience, complication rates are acceptably low and improved clinical outcomes were associated with epi-endo ablation in patients with ICM. Patients with NICM represent a growing referred population, although clinical recurrence remains high despite epicardial ablation. Epicardial ablation has a low yield in idiopathic VA.
authors.affiliation: UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095-1679, USA.
authors.forename: Roderick
authors.initials: R
authors.lastname: Tung
authors.forename: Yoav
authors.initials: Y
authors.lastname: Michowitz
authors.forename: Ricky
authors.initials: R
authors.lastname: Yu
authors.forename: Nilesh
authors.initials: N
authors.lastname: Mathuria
authors.forename: Marmar
authors.initials: M
authors.lastname: Vaseghi
authors.forename: Eric
authors.initials: E
authors.lastname: Buch
authors.forename: Jason
authors.initials: J
authors.lastname: Bradfield
authors.forename: Osamu
authors.initials: O
authors.lastname: Fujimura
authors.forename: Jean
authors.initials: J
authors.lastname: Gima
authors.forename: William
authors.initials: W
authors.lastname: Discepolo
authors.forename: Ravi
authors.initials: R
authors.lastname: Mandapati
authors.forename: Kalyanam
authors.initials: K
authors.lastname: Shivkumar
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000401:mortality / Q000473:pathology / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D056149:Epicardial Mapping / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D017202:Myocardial Ischemia / Q000401:mortality / Q000473:pathology / Q000601:surgery; D061214:Patient Safety; D010496:Pericardium / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome