Abstract
Nonsurgical epicardial transthoracic catheter ablation is a minimally invasive procedure that has proven to be efficacious for the treatment of ventricular tachycardia (VT). The usefulness of this technique depends on the prevalence of epicardial circuits, which seem more frequent in Chagasic than post-myocardial infarction VT. This approach is limited by concern regarding the potential adverse effects of radiofrequency (RF) ablation on the coronary arteries. However, the effects of RF ablation delivered in the vicinity of a major coronary artery are limited to the medial artery. Severe intimal hyperplasia and intravascular thrombosis may occur only when RF ablation is delivered above the artery. Moreover, susceptibility to damage is inversely proportional to the vessel size. Coronary artery injury is an uncommon (< 1%) complication that could be prevented by a coronary angiogram prior to ablation. Hemopericardium, another predictable complication occurring in 10% of patients, can be easily controlled in the electrophysiology laboratory.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References and Recommended Reading
Sosa E, Scanavacca M, d’Avila A, Pilleggi F: A new technique to perform epicardial mapping in the electrophysiology laboratory. J Cardiovasc Electrophysiol 1996, 7:531–536. The first description of this technique in humans.
Sosa E, Scanavacca M, d’Avila A, et al.: Endocardial and epicardial ablation guided by nonsurgical transthoracic epicardial mapping to treat recurrent ventricular tachycardia. J Cardiovasc Electrophysiol 1998, 9:229–239. This manuscript compares the results of epicardial mapping with guide endocardial ablation and epicardial ablation. It emphasizes that VT is always re-inducible when endocardial ablation of an epicardial circuit is attempted.
Sosa E, Scanavacca M, d’Avila A, et al.: Radiofrequency catheter ablation of ventricular tachycardia guided by non-surgical epicardial mapping in chronic Chagasic heart disease. Pacing Clin Electrophysiol 1999, 22:128–130.
Sosa E, Scanavacca M, d’Avila A, et al.: Nonsurgical transthoracic mapping and ablation in a child with incessant ventricular tachycardia. J Cardiovasc Electrophysiol 2000, 1:208–210.
Sosa E, Scanavacca M, d’Avila A, et al.: Nonsurgical transthoracic epicardial catheter ablation to treat recurrent ventricular tachycardia occurring late after myocardial infarction. J Am Coll Cardiol 2000, 35:1442–1449. The article summarizes the initial results obtained with this approach in patients with post-myocardial infarction VT, suggesting that epicardial circuits seem more frequent than expected in this subset of patients.
Tomassoni G, Stanton M, Richey M, et al.: Epicardial mapping and radiofrequency catheter ablation of ischemic ventricular tachycardia using a three-dimensional nonfluoroscopic mapping system. J Cardiovasc Electrophysiol 1999, 10:1643–1648.
Marchlinski FE, Callans DJ, Gottlieb CD, Zado E: Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy. Circulation 2000, 101:1288–1296.
Schilling RJ, Peters NS, Davies DW: Mapping and ablation of ventricular tachycardia with the aid of a non-contact mapping system. Heart 1999, 81:570–575.
Kaltenbrunner W, Cardinal R, Dubuc M, et al.: Epicardial and endocardial mapping of ventricular tachycardia in patients with myocardial infarction: is the origin of the tachycardia always subendocardially localized? Circulation 1991, 84:1058–1071. Discusses the importance of epicardial circuits in the era of catheter ablation.
Svenson RH, Littmann L, Colavita PG, et al. Laser photoablation of ventricular tachycardia: correlation of diastolic activation times and photoablation effects on cycle length and termination: observations supporting a macroreentrant mechanism. J Am Coll Cardiol 1992, 19:607–613. This, and the following reference by Svenson et al. [11], quotes manuscripts that show the importance of epicardial mapping and the existence of epicardial circuits setting the main electrophysiologic and anatomic characteristics.
Svenson RH, Littmann L, Gallagher JJ, et al.: Termination sequence of ventricular tachycardia with epicardial laser photocoagulation: a clinical comparison with patients undergoing successful endocardial photocoagulation alone. J Am Coll Cardiol 1995, 15:163–170. This, and the previous references by Svenson et al. [10], quotes manuscripts that show the importance of epicardial mapping and the existence of epicardial circuits setting the main electrophysiologic and anatomic characteristics.
Verrier R, Waxman S, Lovett E, Moreno R: Transatrial access to the normal pericardial space. Circulation 1998, 98:2331–2333.
Seferovic P, Ristic AD, Maksimovic R, et al.: Initial clinical experience with PerDUCER device: promising new tool in the diagnosis and treatment of pericardial disease. Clin Cardiol 1999, 22:I30-I35.
d’Avila A, Gutierrez P, Scanavacca M, et al.: Effects of RF pulses delivered in the vicinity of the coronary arteries: implications for non-surgical transthoracic epicardial catheter ablation to treat ventricular tachycardia. Pacing Clin Electrophysiol, submitted for publication.
Brugada P, de Swart H, Smeets JL, Wellens HJ: Transcoronary chemical ablation of ventricular tachycardia. Circulation 1989, 79:475–482. Suggests that occlusion of small coronary arteries related to the VT site of origin do not adversely affect ventricular function.
Kay GN, Epstein AE, Bubien RS, et al.: Intracoronary ethanol ablation for the treatment of recurrent sustained ventricular tachycardia. J Am Coll Cardiol 1992, 19:159–168.
Arruda M, Otomo K, Pitha J, et al.: Epicardial left ventricular recordings and radiofrequency catheter ablation from the coronary veins: a potential adjunct approach for mapping and ablation of ventricular tachycardia. Pacing Clin Electrophysiol 1997, 20:1075. The initial report on transvenous RF ablation.
De Paola AAV, Melo WDS, Távora MZP, Martinez EE: Angiographic and electrophysiological substrates for ventricular tachycardia mapping through the coronary veins. Heart 1998, 79:59–63. Reviews the anatomy of the venous system of the heart.
Hehrlein C, Thompson M, Chuang CH, et al.: Selective coagulation necrosis of canine adventia and media induces extracellular matrix accumulation without neointima formation. Atherosclerosis 1995, 113:109–115. Suggests that heating could create lesions restricted to the media of the artery without causing endovascular thrombosis, hyperplasia, or intimal proliferation.
Stevenson WG, Khan H, Sager P, et al.: Identification of reentry circuit sites during catheter mapping and radiofrequency ablation of VT late after myocardial infarction. Circulation 1993, 88:1647–1670. Sets the basis for electrophysiologic analyzes of the electrograms recorded during VT.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sosa, E., Scanavacca, M. & d’Avila, A. Transthoracic epicardial catheter ablation to treat recurrent ventricular tachycardia. Curr Cardiol Rep 3, 451–458 (2001). https://doi.org/10.1007/s11886-001-0066-1
Issue Date:
DOI: https://doi.org/10.1007/s11886-001-0066-1