title: Endo-epicardial versus only-endocardial ablation as a first line strategy for the treatment of ventricular tachycardia in patients with ischemic heart disease.
abstract: BACKGROUND
  Epicardial ablation has shown improvement in clinical outcomes of patients with ischemic heart disease (IHD) after ventricular tachycardia (VT) ablation. However, usually epicardial access is only performed when endocardial ablation has failed. Our aim was to compare the efficacy of endocardial+epicardial ablation versus only endocardial ablation in the first procedure in patients with IHD.
  
  
  RESULTS
  Fifty-three patients with IHD, referred for a first VT ablation to our institution, from 2012 to 2014, were included. They were divided in 2 groups according to enrollment time: from May 2013, we started to systematically perform endo-epicardial access (Epi-Group) as first-line approach in consecutive patients with IHD (n=15). Patients who underwent only an endocardial VT ablation in their first procedure (Endo-Group) included patients with previous cardiac surgery and the historical (before May 2013; n=35). All late-potentials in the scar zone were eliminated, and if VT was tolerated, critical isthmuses were also approached. The end point was the noninducibility of any VT. During a median follow-up of 15±10 months, the combined end point (hospital or emergency admission because of a ventricular tachycardia or reablation) occurred in 14 patients of the Endo-group and in one patient in the Epi-group (event-free survival curves by Grey-test, P=0.03). Ventricular arrhythmia recurrences occurred in 16 and in 3 patients in the Endo and Epi-Group, respectively (Grey-test, P=0.2).
  
  
  CONCLUSIONS
  A combined endocardial-epicardial ablation approach for initial VT ablation was associated with fewer readmissions for VT and repeat ablations. Further studies are warranted.
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, Valencia, Spain (M.I., J.M.S.-G., A.F.d.L.-O., A.M., J.N., C.N., J.C., R.R.-G.); Department of Cardiology, Hospital General, Castellón, Spain (A.B.); and Department of Cardiology, Hospital Doctor Peset, Valencia, Spain (A.P.). maiteizqui@hotmail.com.
authors.forename: Maite
authors.initials: M
authors.lastname: Izquierdo
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, Valencia, Spain (M.I., J.M.S.-G., A.F.d.L.-O., A.M., J.N., C.N., J.C., R.R.-G.); Department of Cardiology, Hospital General, Castellón, Spain (A.B.); and Department of Cardiology, Hospital Doctor Peset, Valencia, Spain (A.P.).
authors.forename: Juan Miguel
authors.initials: JM
authors.lastname: Sánchez-Gómez
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, Valencia, Spain (M.I., J.M.S.-G., A.F.d.L.-O., A.M., J.N., C.N., J.C., R.R.-G.); Department of Cardiology, Hospital General, Castellón, Spain (A.B.); and Department of Cardiology, Hospital Doctor Peset, Valencia, Spain (A.P.).
authors.forename: Angel
authors.initials: A
authors.lastname: Ferrero de Loma-Osorio
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, Valencia, Spain (M.I., J.M.S.-G., A.F.d.L.-O., A.M., J.N., C.N., J.C., R.R.-G.); Department of Cardiology, Hospital General, Castellón, Spain (A.B.); and Department of Cardiology, Hospital Doctor Peset, Valencia, Spain (A.P.).
authors.forename: Angel
authors.initials: A
authors.lastname: Martínez
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, Valencia, Spain (M.I., J.M.S.-G., A.F.d.L.-O., A.M., J.N., C.N., J.C., R.R.-G.); Department of Cardiology, Hospital General, Castellón, Spain (A.B.); and Department of Cardiology, Hospital Doctor Peset, Valencia, Spain (A.P.).
authors.forename: Alejandro
authors.initials: A
authors.lastname: Bellver
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, Valencia, Spain (M.I., J.M.S.-G., A.F.d.L.-O., A.M., J.N., C.N., J.C., R.R.-G.); Department of Cardiology, Hospital General, Castellón, Spain (A.B.); and Department of Cardiology, Hospital Doctor Peset, Valencia, Spain (A.P.).
authors.forename: Antonio
authors.initials: A
authors.lastname: Peláez
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, Valencia, Spain (M.I., J.M.S.-G., A.F.d.L.-O., A.M., J.N., C.N., J.C., R.R.-G.); Department of Cardiology, Hospital General, Castellón, Spain (A.B.); and Department of Cardiology, Hospital Doctor Peset, Valencia, Spain (A.P.).
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, Valencia, Spain (M.I., J.M.S.-G., A.F.d.L.-O., A.M., J.N., C.N., J.C., R.R.-G.); Department of Cardiology, Hospital General, Castellón, Spain (A.B.); and Department of Cardiology, Hospital Doctor Peset, Valencia, Spain (A.P.).
authors.forename: Carlos
authors.initials: C
authors.lastname: Núñez
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, Valencia, Spain (M.I., J.M.S.-G., A.F.d.L.-O., A.M., J.N., C.N., J.C., R.R.-G.); Department of Cardiology, Hospital General, Castellón, Spain (A.B.); and Department of Cardiology, Hospital Doctor Peset, Valencia, Spain (A.P.).
authors.forename: Javier
authors.initials: J
authors.lastname: Chorro
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, Valencia, Spain (M.I., J.M.S.-G., A.F.d.L.-O., A.M., J.N., C.N., J.C., R.R.-G.); Department of Cardiology, Hospital General, Castellón, Spain (A.B.); and Department of Cardiology, Hospital Doctor Peset, Valencia, Spain (A.P.).
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ruiz-Granell
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D004699:Endocardium / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: ablation; chronic ischemic heart disease; electrophysiology