title: Epicardial catheter ablation of ventricular tachycardia in no entry left ventricle: mechanical aortic and mitral valves.
abstract: BACKGROUND
  In patients with mechanical aortic and mitral valves and left ventricular tachycardia, catheter ablation may be prevented by limited access to the left ventricle.
  
  
  RESULTS
  In our series of 6 patients, 2 patients underwent direct surgical ablation and 4 underwent epicardial catheter ablation via a pericardial window. All patients had abnormal low voltage areas with fractionated or delayed isolated potentials on the apical epicardium. Most of the ventricular tachycardias were targeted by pace mapping. Sites with a good pace match or abnormal electrograms were ablated using an irrigated radiofrequency ablation catheter. A microscopic pathological evaluation of the resected tissue from 2 of the open-heart ablation patients revealed dense fibrosis on the epicardium compared with the endocardium, supporting the feasibility of an epicardial ablation for the ventricular tachycardia.
  
  
  CONCLUSIONS
  Epicardial catheter ablation of ventricular tachycardia is a potentially useful therapy in patients who have mechanical aortic and mitral valves.
authors.affiliation: From the Department of Cardiology, Kyorin University Hospital, Tokyo, Japan (K.S., A.U., Y.M., T.S., H.Y.); Cardiovascular Division, University of Tsukuba, Tsukuba, Japan (A.N., Y.S., N.M., K.A.); Department of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan (T.H., S.N.); Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan (K.S.); Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan (T.H.); Tokyo Medical and Dental University Hospital, Tokyo, Japan (Y.S.); Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan (S. Kowase); Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan (S. Kunugi); Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (H.M.); and Department of Cardiovascular Surgery, Nippon Medical School of Medicine, Tokyo, Japan (T.N.).
authors.forename: Kyoko
authors.initials: K
authors.lastname: Soejima
authors.affiliation: From the Department of Cardiology, Kyorin University Hospital, Tokyo, Japan (K.S., A.U., Y.M., T.S., H.Y.); Cardiovascular Division, University of Tsukuba, Tsukuba, Japan (A.N., Y.S., N.M., K.A.); Department of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan (T.H., S.N.); Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan (K.S.); Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan (T.H.); Tokyo Medical and Dental University Hospital, Tokyo, Japan (Y.S.); Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan (S. Kowase); Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan (S. Kunugi); Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (H.M.); and Department of Cardiovascular Surgery, Nippon Medical School of Medicine, Tokyo, Japan (T.N.).
authors.forename: Akihiko
authors.initials: A
authors.lastname: Nogami
authors.affiliation: From the Department of Cardiology, Kyorin University Hospital, Tokyo, Japan (K.S., A.U., Y.M., T.S., H.Y.); Cardiovascular Division, University of Tsukuba, Tsukuba, Japan (A.N., Y.S., N.M., K.A.); Department of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan (T.H., S.N.); Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan (K.S.); Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan (T.H.); Tokyo Medical and Dental University Hospital, Tokyo, Japan (Y.S.); Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan (S. Kowase); Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan (S. Kunugi); Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (H.M.); and Department of Cardiovascular Surgery, Nippon Medical School of Medicine, Tokyo, Japan (T.N.).
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sekiguchi
authors.affiliation: From the Department of Cardiology, Kyorin University Hospital, Tokyo, Japan (K.S., A.U., Y.M., T.S., H.Y.); Cardiovascular Division, University of Tsukuba, Tsukuba, Japan (A.N., Y.S., N.M., K.A.); Department of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan (T.H., S.N.); Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan (K.S.); Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan (T.H.); Tokyo Medical and Dental University Hospital, Tokyo, Japan (Y.S.); Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan (S. Kowase); Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan (S. Kunugi); Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (H.M.); and Department of Cardiovascular Surgery, Nippon Medical School of Medicine, Tokyo, Japan (T.N.).
authors.forename: Tomoo
authors.initials: T
authors.lastname: Harada
authors.affiliation: From the Department of Cardiology, Kyorin University Hospital, Tokyo, Japan (K.S., A.U., Y.M., T.S., H.Y.); Cardiovascular Division, University of Tsukuba, Tsukuba, Japan (A.N., Y.S., N.M., K.A.); Department of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan (T.H., S.N.); Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan (K.S.); Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan (T.H.); Tokyo Medical and Dental University Hospital, Tokyo, Japan (Y.S.); Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan (S. Kowase); Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan (S. Kunugi); Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (H.M.); and Department of Cardiovascular Surgery, Nippon Medical School of Medicine, Tokyo, Japan (T.N.).
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Satomi
authors.affiliation: From the Department of Cardiology, Kyorin University Hospital, Tokyo, Japan (K.S., A.U., Y.M., T.S., H.Y.); Cardiovascular Division, University of Tsukuba, Tsukuba, Japan (A.N., Y.S., N.M., K.A.); Department of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan (T.H., S.N.); Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan (K.S.); Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan (T.H.); Tokyo Medical and Dental University Hospital, Tokyo, Japan (Y.S.); Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan (S. Kowase); Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan (S. Kunugi); Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (H.M.); and Department of Cardiovascular Surgery, Nippon Medical School of Medicine, Tokyo, Japan (T.N.).
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hirose
authors.affiliation: From the Department of Cardiology, Kyorin University Hospital, Tokyo, Japan (K.S., A.U., Y.M., T.S., H.Y.); Cardiovascular Division, University of Tsukuba, Tsukuba, Japan (A.N., Y.S., N.M., K.A.); Department of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan (T.H., S.N.); Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan (K.S.); Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan (T.H.); Tokyo Medical and Dental University Hospital, Tokyo, Japan (Y.S.); Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan (S. Kowase); Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan (S. Kunugi); Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (H.M.); and Department of Cardiovascular Surgery, Nippon Medical School of Medicine, Tokyo, Japan (T.N.).
authors.forename: Akiko
authors.initials: A
authors.lastname: Ueda
authors.affiliation: From the Department of Cardiology, Kyorin University Hospital, Tokyo, Japan (K.S., A.U., Y.M., T.S., H.Y.); Cardiovascular Division, University of Tsukuba, Tsukuba, Japan (A.N., Y.S., N.M., K.A.); Department of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan (T.H., S.N.); Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan (K.S.); Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan (T.H.); Tokyo Medical and Dental University Hospital, Tokyo, Japan (Y.S.); Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan (S. Kowase); Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan (S. Kunugi); Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (H.M.); and Department of Cardiovascular Surgery, Nippon Medical School of Medicine, Tokyo, Japan (T.N.).
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Miwa
authors.affiliation: From the Department of Cardiology, Kyorin University Hospital, Tokyo, Japan (K.S., A.U., Y.M., T.S., H.Y.); Cardiovascular Division, University of Tsukuba, Tsukuba, Japan (A.N., Y.S., N.M., K.A.); Department of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan (T.H., S.N.); Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan (K.S.); Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan (T.H.); Tokyo Medical and Dental University Hospital, Tokyo, Japan (Y.S.); Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan (S. Kowase); Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan (S. Kunugi); Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (H.M.); and Department of Cardiovascular Surgery, Nippon Medical School of Medicine, Tokyo, Japan (T.N.).
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Sato
authors.affiliation: From the Department of Cardiology, Kyorin University Hospital, Tokyo, Japan (K.S., A.U., Y.M., T.S., H.Y.); Cardiovascular Division, University of Tsukuba, Tsukuba, Japan (A.N., Y.S., N.M., K.A.); Department of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan (T.H., S.N.); Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan (K.S.); Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan (T.H.); Tokyo Medical and Dental University Hospital, Tokyo, Japan (Y.S.); Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan (S. Kowase); Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan (S. Kunugi); Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (H.M.); and Department of Cardiovascular Surgery, Nippon Medical School of Medicine, Tokyo, Japan (T.N.).
authors.forename: Satoru
authors.initials: S
authors.lastname: Nishio
authors.affiliation: From the Department of Cardiology, Kyorin University Hospital, Tokyo, Japan (K.S., A.U., Y.M., T.S., H.Y.); Cardiovascular Division, University of Tsukuba, Tsukuba, Japan (A.N., Y.S., N.M., K.A.); Department of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan (T.H., S.N.); Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan (K.S.); Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan (T.H.); Tokyo Medical and Dental University Hospital, Tokyo, Japan (Y.S.); Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan (S. Kowase); Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan (S. Kunugi); Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (H.M.); and Department of Cardiovascular Surgery, Nippon Medical School of Medicine, Tokyo, Japan (T.N.).
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shirai
authors.affiliation: From the Department of Cardiology, Kyorin University Hospital, Tokyo, Japan (K.S., A.U., Y.M., T.S., H.Y.); Cardiovascular Division, University of Tsukuba, Tsukuba, Japan (A.N., Y.S., N.M., K.A.); Department of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan (T.H., S.N.); Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan (K.S.); Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan (T.H.); Tokyo Medical and Dental University Hospital, Tokyo, Japan (Y.S.); Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan (S. Kowase); Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan (S. Kunugi); Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (H.M.); and Department of Cardiovascular Surgery, Nippon Medical School of Medicine, Tokyo, Japan (T.N.).
authors.forename: Shinya
authors.initials: S
authors.lastname: Kowase
authors.affiliation: From the Department of Cardiology, Kyorin University Hospital, Tokyo, Japan (K.S., A.U., Y.M., T.S., H.Y.); Cardiovascular Division, University of Tsukuba, Tsukuba, Japan (A.N., Y.S., N.M., K.A.); Department of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan (T.H., S.N.); Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan (K.S.); Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan (T.H.); Tokyo Medical and Dental University Hospital, Tokyo, Japan (Y.S.); Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan (S. Kowase); Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan (S. Kunugi); Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (H.M.); and Department of Cardiovascular Surgery, Nippon Medical School of Medicine, Tokyo, Japan (T.N.).
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Murakoshi
authors.affiliation: From the Department of Cardiology, Kyorin University Hospital, Tokyo, Japan (K.S., A.U., Y.M., T.S., H.Y.); Cardiovascular Division, University of Tsukuba, Tsukuba, Japan (A.N., Y.S., N.M., K.A.); Department of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan (T.H., S.N.); Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan (K.S.); Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan (T.H.); Tokyo Medical and Dental University Hospital, Tokyo, Japan (Y.S.); Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan (S. Kowase); Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan (S. Kunugi); Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (H.M.); and Department of Cardiovascular Surgery, Nippon Medical School of Medicine, Tokyo, Japan (T.N.).
authors.forename: Shinobu
authors.initials: S
authors.lastname: Kunugi
authors.affiliation: From the Department of Cardiology, Kyorin University Hospital, Tokyo, Japan (K.S., A.U., Y.M., T.S., H.Y.); Cardiovascular Division, University of Tsukuba, Tsukuba, Japan (A.N., Y.S., N.M., K.A.); Department of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan (T.H., S.N.); Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan (K.S.); Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan (T.H.); Tokyo Medical and Dental University Hospital, Tokyo, Japan (Y.S.); Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan (S. Kowase); Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan (S. Kunugi); Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (H.M.); and Department of Cardiovascular Surgery, Nippon Medical School of Medicine, Tokyo, Japan (T.N.).
authors.forename: Hiroshige
authors.initials: H
authors.lastname: Murata
authors.affiliation: From the Department of Cardiology, Kyorin University Hospital, Tokyo, Japan (K.S., A.U., Y.M., T.S., H.Y.); Cardiovascular Division, University of Tsukuba, Tsukuba, Japan (A.N., Y.S., N.M., K.A.); Department of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan (T.H., S.N.); Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan (K.S.); Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan (T.H.); Tokyo Medical and Dental University Hospital, Tokyo, Japan (Y.S.); Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan (S. Kowase); Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan (S. Kunugi); Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (H.M.); and Department of Cardiovascular Surgery, Nippon Medical School of Medicine, Tokyo, Japan (T.N.).
authors.forename: Takashi
authors.initials: T
authors.lastname: Nitta
authors.affiliation: From the Department of Cardiology, Kyorin University Hospital, Tokyo, Japan (K.S., A.U., Y.M., T.S., H.Y.); Cardiovascular Division, University of Tsukuba, Tsukuba, Japan (A.N., Y.S., N.M., K.A.); Department of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan (T.H., S.N.); Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan (K.S.); Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan (T.H.); Tokyo Medical and Dental University Hospital, Tokyo, Japan (Y.S.); Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan (S. Kowase); Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan (S. Kunugi); Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (H.M.); and Department of Cardiovascular Surgery, Nippon Medical School of Medicine, Tokyo, Japan (T.N.).
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
authors.affiliation: From the Department of Cardiology, Kyorin University Hospital, Tokyo, Japan (K.S., A.U., Y.M., T.S., H.Y.); Cardiovascular Division, University of Tsukuba, Tsukuba, Japan (A.N., Y.S., N.M., K.A.); Department of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan (T.H., S.N.); Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan (K.S.); Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan (T.H.); Tokyo Medical and Dental University Hospital, Tokyo, Japan (Y.S.); Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan (S. Kowase); Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan (S. Kunugi); Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (H.M.); and Department of Cardiovascular Surgery, Nippon Medical School of Medicine, Tokyo, Japan (T.N.).
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yoshino
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005240:Feasibility Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D010491:Pericardial Window Techniques; D010496:Pericardium / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D012189:Retrospective Studies; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007507:Therapeutic Irrigation / Q000295:instrumentation; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: aortic valve; catheter ablation; mitral valve; tachycardia, ventricular