Abstract 17550: Prospective and Randomized Study of Efficacy and Safety of Epicardial Ablation of Ventricular Tachycardia in Patients With Chagas Disease Using Contact Force Sensor Irrigated Tip Catheter
Introduction: Epicardial mapping and ablation is frequently necessary for non-ischemic cardiomyopathy, especially Chagas Disease patients. Although, there is no randomized study proving its superiority.
Hypothesis: Combined approach is more effective than endo only, being safe.
Methods: We selected 20 patients with Chagas disease referred for VT ablation that were randomized to (1) endocardial only group or (2) combined epi/endo group. In the combined group ablation was performed in the surface of optimal signals during VT or substrate mapping. In the endo only group, ablation was performed initially only in the endo, if there was no scar or clinical VT was still induced, epicardial puncture was performed and crossover occurred. The endpoint was efficacy, measured by VT reinducibility and safety measured by rate of complications.
Results: Most of the patients were male (7 in the endo and 6 in combined), the median age was 65 (Q1: 57, Q3: 69) and 56 (Q1: 42, Q3:61; P=0,03) years-old and LVEF was 336% and 3311% (P=NS), respectively. In the endo only group ablation failed in eight patients and complete success was obtained in two. In two there was failure of ablation and crossover was not performed, in the remaining six patient crossover was performed, in three there was no endo scar and in the other three VT was still inducible after endo ablation. After crossover, complete success was obtained in four patients, partial success in four and failure in two patients. In the combined group complete success was obtained in 3 patients, partial success in 6 and failure in one patient. RF applications were performed in epicardial surface in all patients. There was a significant fewer failure for the combined group (10% vs 80%, P=0,003). Including crossover, the difference disappeared (10% vs 20%, P=0,64). There was a higher number of RV puncture in the endo only group after crossover, but this difference was not significant. The amount of drained blood after RV puncture was similar in both groups as well as the number of patients and number of days that the pig-tail catheter was maintained.
Conclusions: In this randomized trial of epicardial and endocardial VT ablation in Chagas Disease there was less failure of ablation when combined endo/epi approach was used. Both approached were safe.
Author Disclosures: C. Pisani: None. S. Lara: None. C. Hardy: None. M. Chokr: None. H. Bellotti: None. A. Guabiru: None. L. Sacilotto: None. F. Darrieux: None. D. Hachul: None. M. Scanavacca: None.
- © 2016 by American Heart Association, Inc.