Endocardial ablation to eliminate epicardial arrhythmia substrate in scar-related ventricular tachycardia.
OBJECTIVE
We evaluated the feasibility and safety of epicardial substrate elimination with endocardial radiofrequency (RF) delivery in patients with scar-related ventricular tachycardia (VT).


BACKGROUND
Epicardial RF delivery is limited by fat or associated with bleeding, extra-cardiac damages, coronary vessels and phrenic nerve injury. Alternative ablation approaches might be desirable.


METHODS
Forty-six patients (18 ischemic cardiomyopathy [ICM], 13 nonischemic dilated cardiomyopathy [NICM], 15 arrhythmogenic right ventricular cardiomyopathy [ARVC]) with sustained VT underwent combined endo- and epicardial mapping. All patients received endocardial ablation targeting local abnormal ventricular activities in the endocardium (Endo-LAVA) and epicardium (Epi-LAVA), followed by epicardial ablation if needed.


RESULTS
From a total of 173 endocardial ablations targeting Epi-LAVA at the facing site, 48 (28%) applications (ICM: 20 of 71 [28%], NICM: 3 of 39 [8%], ARVC: 25 of 63 [40%]) successfully eliminated the Epi-LAVA. Presence of Endo-LAVA, the most delayed and low bipolar amplitude of Epi-LAVA, low unipolar amplitude in the facing endocardium, and Epi-LAVA within a wall thinning area at computed tomography scan were associated with successful ablation. Endocardial ablation could abolish all Epi-LAVA in 4 ICM and 2 ARVC patients, whereas all patients with NICM required epicardial ablation. Endocardial ablation was able to eliminate Epi-LAVA at least partially in 15 (83%) ICM, 2 (13%) NICM, and 11 (73%) ARVC patients, contributing to a potential reduction in epicardial RF applications. Pericardial bleeding occurred in 4 patients with epicardial ablation.


CONCLUSIONS
Elimination of Epi-LAVA with endocardial RF delivery is feasible and might be used first to reduce the risk of epicardial ablation.
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France. Electronic address: yk.komat@gmail.com.
Yuki
Y
Komatsu
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.
Matthew
M
Daly
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.
Frédéric
F
Sacher
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.
Hubert
H
Cochet
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.
Arnaud
A
Denis
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.
Nicolas
N
Derval
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.
Laurence
L
Jesel
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.
Stephan
S
Zellerhoff
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.
Han S
HS
Lim
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.
Amir
A
Jadidi
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.
Isabelle
I
Nault
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.
Ashok
A
Shah
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.
Laurent
L
Roten
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.
Patrizio
P
Pascale
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.
Daniel
D
Scherr
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.
Valerie
V
Aurillac-Lavignolle
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.
Mélèze
M
Hocini
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.
Michel
M
Haïssaguerre
Department of Cardiac Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux II, Institut LYRIC, Equipex MUSIC, Bordeaux, France.
Pierre
P
Jaïs
D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods* / Q000401:mortality; D002921:Cicatrix / Q000150:complications* / Q000473:pathology; D015331:Cohort Studies; D004562:Electrocardiography / Q000379:methods; D004699:Endocardium / Q000601:surgery; D056149:Epicardial Mapping / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome
ablation; arrhythmia; epicardium; local abnormal ventricular activities; ventricular tachycardia