Abstract 12112: Clinical Outcomes of Percutaneous Epicardial Ablation
Introduction: Percutaneous epicardial access (EAc) is increasingly performed as part of VT/PVC ablation, especially in those that have failed prior ablation. We aimed to delineate the outcomes of EAc.
Methods: We retrospectively analyzed individuals undergoing EAc for arrhythmia ablation between June 2004 and July 2014. Acute procedural success was defined as elimination/non-inducibility of the clinical arrhythmia after ablation; clinical success was defined as absence of symptoms/arrhythmia.
Results: Of 175 patients, 126 (72%) were male with a mean age of 52.8±15.7 years. Eighty-three (47.4%) patients had NICM, 25 (14.3%) had ICM and 34 (19.4%) had normal hearts. Baseline EF was 44±16%. Patients had failed an average of 1.7±1.2 antiarrhythmic drugs; 139 patients (79%) had failed prior endocardial (endo) ablation (average 1.3±1.1). Six (3.4%) had prior EAc and 18 (10.3%) prior cardiac surgery. The indication for ablation was VT or PVC in 113 (64.6%) and 60 (34.3%) patients, respectively. Successful access was obtained in 168 (98%) patients. Anterior access, inferior access, or both, was utilized in 89 (52.7%), 77 (45.6%) and 2 (1.2%) patients, respectively. There were an average of 2.7±2.2 VT/PVCs identified, and 1.6±1.1 ablated. Endo, epicardial (epi) or combined ablation was performed in 58 (33.1%), 14 (8%), and 100 (57.1%) patients, respectively; 3 did not undergo ablation. Procedural success was obtained in 158 of 173 (91.3%) patients for whom data was available. At 12 months, clinical success was maintained in 62% with no difference between endo, epi or combined ablation (figure). Cardiac tamponade requiring repeat EAc occurred in 12 (6.9%) patients. There were no procedural related deaths.
Conclusion: Epicardial access is feasible in almost all patients with no prior cardiac surgery, and permits acute procedural success in 91.3% of patients, most of whom had failed previous ablation. Furthermore, complications are relatively infrequent in this complex cohort.
Author Disclosures: A.M. Killu: None. M. Al-Hijji: None. A.M. Sugrue: None. C.J. McLeod: None. D.O. Hodge: None. T.M. Munger: None. S.K. Mulpuru: None. D.L. Packer: Research Grant; Modest; Endosense, EP Advocate, CardioFocus, Hansen Medical, Siemens Acuson, Thermomedical (EP Limited), CardioInsight. Research Grant; Significant; American Heart Association, Biosense Webster, Boston Scientific/ EPT, EpiEP, Medtronic, National Institutes of Health, St. Jude Medical. Other; Modest; Blackwell Publishing, Oxford Rolalty. Other; Significant; St. Jude Medical. S.J. Asirvatham: Honoraria; Modest; Abiomed, Atricure, Biotronik, Biosense Webster, Boston Scientific, Medtronic, St. Jude Medical, Sanofi-Aventis, Wolters Kluwer, Elsevier. Other; Modest; Aegis, Access Point Technologies, Nevro, Sanovas, Sorin Medical. P.A. Friedman: Research Grant; Modest; St. Jude Medical. Speakers Bureau; Modest; Medtronic, Leadex, Boston Scientific. Other; Modest; Aegis, NeoChord, Preventice, Sorin.
- © 2015 by American Heart Association, Inc.