Open surgical ablation of ventricular tachycardia: Utility and feasibility of contemporary mapping and ablation tools

Heart Rhythm O2

Ryan T. Borne, MD¹  Peter Sauer²  Duy T. Nguyen, MD, FHRS³  William H. Sauer, MD, FHRS³  Matthew M. Zipse, MD⁴  Peter Rothstein, MD⁵  Wendy S. Tzou, MD, FHRS⁶  Alexis Z. Tumolo, MD⁷  Ryan G. Aleong, MD⁷  Amneet Sandhu, MS, MD⁷  David Fullerton, MD⁷  Jay D. Pal, MD, PhD⁷  Joseph C. Cleveland, Jr., MD⁷  Megan Kunkel, BS⁷  Austin S. Davies, BS⁷  Curtis Lane, BS⁷ 

[1] VA Eastern Colorado Health Care System, Aurora, Colorado;Vascular Center, Houston, Texas;Abbott, St. Paul, Minnesota;Brigham and Women's Hospital, Cardiac Arrhythmia Service, Boston, Massachusetts;;Houston Methodist DeBakey Heart &Stanford University, Section of Electrophysiology, Division of Cardiology, Palo Alto, California;University of Colorado School of Medicine, Division of Cardiology, Section of Cardiac Electrophysiologist, Aurora, Colorado;

关键词: Epicardial ablation;    Surgical ablation;    Ventricular arrhythmia;    Ventricular tachycardia;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Ventricular tachycardia (VT) catheter ablation success may be limited when transcutaneous epicardial access is contraindicated. Surgical ablation (SurgAbl) is an option, but ablation guidance is limited without simultaneously acquired electrophysiological data. Objective: We describe our SurgAbl experience utilizing contemporary electroanatomic mapping (EAM) among patients with refractory VT storm. Methods: Consecutive patients with recurrent VT despite antiarrhythmic drugs (AADs) and prior ablation, for whom percutaneous epicardial access was contraindicated, underwent open SurgAbl using intraoperative EAM guidance. Results: Eight patients were included, among whom mean age was 63 ± 5 years, all were male, mean left ventricular ejection fraction was 39% ± 12%, and 2 (25%) had ischemic cardiomyopathy. Reasons for surgical epicardial access included dense adhesions owing to prior cardiac surgery, hemopericardium, or pericarditis (n = 6); or planned left ventricular assist device (LVAD) implantation at time of SurgAbl (n = 2). Cryoablation guided by real-time EAM was performed in all. Goals of clinical VT noninducibility or core isolation were achieved in 100%. VT burden was significantly reduced, from median 15 to 0 events in the month pre- and post-SurgAbl (P = .01). One patient underwent orthotopic heart transplantation for recurrent VT storm 2 weeks post-SurgAbl. Over mean follow-up of 3.4 ± 1.7 years, VT storm–free survival was achieved in 6 (75%); all continued AADs, although at lower dose. Conclusion: Surgical mapping and ablation of refractory VT with use of contemporary EAM is feasible and effective, particularly among patients with contraindication to percutaneous epicardial access or with another indication for cardiac surgery.

【 授权许可】

Unknown