Abstract 14425: Anatomic Characteristics of Right Ventricular Epicardium Affecting Epicardial Catheter Ablation
Introduction: Catheter ablation at the anterior right ventricular (RV) outflow tract epicardium has resulted in ventricular arrhythmia prevention in patients with Brugada syndrome. However, little information is available on anterior RV epicardium anatomy. We assessed the hypothesis that assessing coronary artery branches and fat thickness at the anterior RV epicardium are essential to precluding coronary injury and catheter ablation failure. We investigate anatomy coronary-artery variations at the anterior RV epicardium and measure the thickness and volume of anterior RV epicardial fat, using cardiac computed tomography.
Methods and Results: We analyzed 60 patients (age 65±9, 50% male) without coronary artery disease who underwent cardiac computed tomography. We divided the anterior RV epicardium into three areas: (A) upper anterior RV, (B) lower anterior RV, and (C) basal RV. The major anterior RV epicardium arteries are the conus branch and RV branch of the right coronary artery (RCA). In all, 70 conus branches were analyzed. Forty-six (66%) conus branches arise from the RCA, 17 (24%) in proximity with the RCA ostium, and 7 (10%) from the aorta. Twelve (17%) conus branches bifurcated. There were 43 (61%) conus branches in the upper anterior RV, 3 (4%) in the lower anterior RV, and 34 (35%) in the basal RV. Of the 63 RV branches, none were present in the upper anterior RV , 19 (30%) were in the basal RV, and 44 (70%) reached to the lower anterior RV. The thickness of epicardial fat was 4.8±2.5 mm in the upper anterior RV, 5.2±2.6 mm in the lower anterior RV, and 4.6±2.7mm in the basal RV. The total epicardial fat volume at the anterior RV was 16±8 ml_significantly larger than that at the anterior left ventricle (8±5 ml, p<0.01)
Conclusion: Conus branches were found in the upper anterior RV epicardium area of many patients, and there is often a thick layer of epicardial fat in the anterior RV. Therefore, catheter ablation at the epicaridial anterior RV must be performed with utmost care.
- © 2012 by American Heart Association, Inc.