title: Safety and Feasibility of Open Chest Epicardial Mapping and Ablation of Ventricular Tachycardia During the Period of Left Ventricular Assist Device Implantation.
abstract: BACKGROUND
  Patients undergoing catheter ablation for ventricular tachycardia (VT) may require epicardial mapping. In patients with end-stage heart failure, hybrid surgical epicardial mapping and ablation during the period of left ventricular assist device (LVAD) implantation may be considered in select patients to reduce post-LVAD ventricular tachycardia.
  
  
  RESULTS
  From March 2009 to October 2012, 5 patients (4 men and 1 woman, age range 52-73 years) underwent open chest electrophysiology study and epicardial mapping for recurrent ventricular tachycardia while the heart was exposed during the period of LVAD implantation. Epicardial mapping was considered if patients had recurrent VT despite failed prior endocardial ablation and/or electrocardiogram (EKG) features of an epicardial exit. Activation and/or a substrate mapping approach were employed during all procedures. Three of 5 patients (60%) had acute procedural success. In all patients, VT was either eliminated or significantly reduced with epicardial ablation. One patient had mediastinal bleeding delaying sternal closure. During a follow-up period of 363 ± 368 days, 4 patients died due to nonarrhythmic causes.
  
  
  CONCLUSIONS
  Open-chest hybrid epicardial mapping and ablation for recurrent VT is feasible and can be considered in select patients during the period of LVAD implantation.
authors.affiliation: Baylor St. Luke's Medical Center/Texas Heart Institute, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Mehul
authors.initials: M
authors.lastname: Patel
authors.affiliation: Baylor St. Luke's Medical Center/Texas Heart Institute, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Francia
authors.initials: F
authors.lastname: Rojas
authors.affiliation: Baylor St. Luke's Medical Center/Texas Heart Institute, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Farshad Raissi
authors.initials: FR
authors.lastname: Shabari
authors.affiliation: Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Leo
authors.initials: L
authors.lastname: Simpson
authors.affiliation: Division of Cardiovascular Surgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: William
authors.initials: W
authors.lastname: Cohn
authors.affiliation: Division of Cardiovascular Surgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: O H
authors.initials: OH
authors.lastname: Frazier
authors.affiliation: Division of Cardiovascular Surgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Hari
authors.initials: H
authors.lastname: Mallidi
authors.affiliation: Baylor St. Luke's Medical Center/Texas Heart Institute, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Cheng
authors.affiliation: Baylor St. Luke's Medical Center/Texas Heart Institute, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Nilesh
authors.initials: N
authors.lastname: Mathuria
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects; D004562:Electrocardiography; D056149:Epicardial Mapping / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: LVAD; ablation; epicardial; open chest; ventricular tachycardia