医学
烧蚀
卫生棉条
室性心动过速
心脏压塞
心脏病学
内科学
缺血性心肌病
心肌病
导管消融
心动过速
单中心
并发症
外科
心力衰竭
射血分数
作者
Roderick Tung,Yoav Michowitz,Ricky Yu,Nilesh Mathuria,Marmar Vaseghi,Éric Buch,Jason S. Bradfield,Osamu Fujimura,Jean Gima,William Discepolo,Ravi Mandapati,Kalyanam Shivkumar
出处
期刊:Heart Rhythm
[Elsevier]
日期:2013-04-01
卷期号:10 (4): 490-498
被引量:133
标识
DOI:10.1016/j.hrthm.2012.12.013
摘要
Epicardial ablation has been shown to be a useful adjunct for treatment of ventricular tachycardia (VT).To report the trends, safety, and efficacy of epicardial mapping and ablation at a single center over an 8-year period.Patients referred for VT ablation (June 2004 to July 2011) were divided into 3 groups: ischemic cardiomyopathy (ICM), nonischemic cardiomyopathy (NICM), and idiopathic ventricular arrhythmias (VA). Patients with scar-mediated VT who underwent combined epicardial and endocardial (epi-endo) mapping and ablation were compared with those who underwent endocardial-only (endo-only) ablation with regard to patient characteristics, acute procedural success, 6- and 12-month clinical outcomes.Among 144 patients referred for VT ablation, 95 patients underwent 109 epicardial procedures (94% access rate). Major complications were seen in 8 patients (8.8%) with pericardial bleeding (>80 cm(3)) in 6 cases (6.7%), although no tamponade, surgical intervention, or procedural mortality was seen. Patients with ICM who underwent a combined epi-endo ablation had improved freedom from VT compared with those who underwent endo-only ablation at 12 months (85% vs 56%; P = .03). In patients with NICM, no differences were seen between those who underwent epi-endo ablation and those who underwent endo-only ablation at 12 months (36% vs 33%; P = 1.0). In idiopathic VA, only 2 of 17 patients were successfully ablated from the epicardium.In this large tertiary single-center experience, complication rates are acceptably low and improved clinical outcomes were associated with epi-endo ablation in patients with ICM. Patients with NICM represent a growing referred population, although clinical recurrence remains high despite epicardial ablation. Epicardial ablation has a low yield in idiopathic VA.
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