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CLINICAL RESEARCH: ELECTROPHYSIOLOGICAL DISORDERS

Nonsurgical transthoracic epicardial radiofrequency ablation

An alternative in incessant ventricular tachycardia

^* Arrhythmia Section, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain

Manuscript received October 29, 2002; revised manuscript received December 17, 2002, accepted January 16, 2003.

^* Reprint requests and correspondence: Dr. Josep Brugada, Arrhythmia Section, Cardiovascular Institute, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain.
jbrugada{at}clinic.ub.es

OBJECTIVES: The purpose of this study was to analyze the feasibility, efficacy, and safety of epicardial radiofrequency (RF) ablation in patients with incessant ventricular tachycardia (VT).

BACKGROUND: Management of patients with incessant VT is a difficult clinical problem. Drugs and RF catheter ablation are not always effective. A nonsurgical transthoracic epicardial RF ablation can be an alternative in patients refractory to conventional therapy.

METHODS: Epicardial RF ablation was performed in 10 patients who presented with incessant VT despite the use of two or more intravenous antiarrhythmic drugs.

RESULTS: In eight patients, endocardial ablation (EdA) failed to control the tachycardia. In the remaining two patients, epicardial ablation (EpA) was first attempted because of left ventricular thrombus and severe artery disease, respectively. Eight patients had a diagnosis of coronary artery disease with healed myocardial infarction. One patient had dilated cardiomyopathy, and one patient had idiopathic, incessant VT. In patients with structural heart disease, the mean ejection fraction was 0.28 ± 0.10%. Four patients previously received an implantable defibrillator. The EpA effectively terminated the incessant tachycardia in eight patients, which represents a success rate of 80%. In them, after a follow-up of 18 ± 18 months, a single episode of a different VT was documented in one patient. No significant complications occurred related to the procedure.

CONCLUSIONS: In patients with incessant VT despite the use of drugs or standard EdA, the epicardial approach was very effective and should be considered as an alternative in this life-threatening situation.

Abbreviations and Acronyms   CAD   coronary artery disease   ECG   electrocardiogram   EdA   endocardial ablation   EpA   epicardial ablation   LBBB   left bundle branch block   MI   myocardial infarction   RF   radiofrequency   SVT   supraventricular tachycardia   VT   ventricular tachycardia

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