Kyoko Soejima1, Akihiko Nogami1, Yukio Sekiguchi1, Tomoo Harada1, Kazuhiro Satomi1, Takeshi Hirose1, Akiko Ueda1, Yousuke Miwa1, Toshiaki Sato1, Satoru Nishio1, Yasuhiro Shirai1, Shinya Kowase1, Nobuyuki Murakoshi1, Shinobu Kunugi1, Hiroshige Murata1, Takashi Nitta1, Kazutaka Aonuma1, Hideaki Yoshino1. 1. From the Department of Cardiology, Kyorin University Hospital, Tokyo, Japan (K.S., A.U., Y.M., T.S., H.Y.); Cardiovascular Division, University of Tsukuba, Tsukuba, Japan (A.N., Y.S., N.M., K.A.); Department of Cardiology, St. Marianna University School of Medicine Hospital, Kanagawa, Japan (T.H., S.N.); Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan (K.S.); Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan (T.H.); Tokyo Medical and Dental University Hospital, Tokyo, Japan (Y.S.); Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan (S. Kowase); Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan (S. Kunugi); Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (H.M.); and Department of Cardiovascular Surgery, Nippon Medical School of Medicine, Tokyo, Japan (T.N.).
Abstract
BACKGROUND: In patients with mechanical aortic and mitral valves and left ventricular tachycardia, catheter ablation may be prevented by limited access to the left ventricle. METHODS AND RESULTS: In our series of 6 patients, 2 patients underwent direct surgical ablation and 4 underwent epicardial catheter ablation via a pericardial window. All patients had abnormal low voltage areas with fractionated or delayed isolated potentials on the apical epicardium. Most of the ventricular tachycardias were targeted by pace mapping. Sites with a good pace match or abnormal electrograms were ablated using an irrigated radiofrequency ablation catheter. A microscopic pathological evaluation of the resected tissue from 2 of the open-heart ablation patients revealed dense fibrosis on the epicardium compared with the endocardium, supporting the feasibility of an epicardial ablation for the ventricular tachycardia. CONCLUSIONS: Epicardial catheter ablation of ventricular tachycardia is a potentially useful therapy in patients who have mechanical aortic and mitral valves.
BACKGROUND: In patients with mechanical aortic and mitral valves and left ventricular tachycardia, catheter ablation may be prevented by limited access to the left ventricle. METHODS AND RESULTS: In our series of 6 patients, 2 patients underwent direct surgical ablation and 4 underwent epicardial catheter ablation via a pericardial window. All patients had abnormal low voltage areas with fractionated or delayed isolated potentials on the apical epicardium. Most of the ventricular tachycardias were targeted by pace mapping. Sites with a good pace match or abnormal electrograms were ablated using an irrigated radiofrequency ablation catheter. A microscopic pathological evaluation of the resected tissue from 2 of the open-heart ablation patients revealed dense fibrosis on the epicardium compared with the endocardium, supporting the feasibility of an epicardial ablation for the ventricular tachycardia. CONCLUSIONS: Epicardial catheter ablation of ventricular tachycardia is a potentially useful therapy in patients who have mechanical aortic and mitral valves.