Peng-Pai Zhang1,2, Christian-Hendrik Heeger1,3,4, Shibu Mathew1, Thomas Fink1, Bruno Reissmann1, Christine Lemeš1, Tilman Maurer1, Francesco Santoro1, YingHao Huang1, Johannes Riedl1, Michael Schmoeckel5, Andreas Rillig1, Andreas Metzner1, Karl-Heinz Kuck1, Feifan Ouyang6,7. 1. Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. 2. Department of Cardiology, Shanghai Xinhua Hospital Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, China. 3. Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, University Heart Center Lübeck, Lübeck, Germany. 4. German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany. 5. Department of Cardiovascular Surgery, Asklepios Klinik St. Georg, Hamburg, Germany. 6. Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. ffouyang@yahoo.com. 7. Fuwai Hospital/National Center of Cardiovascular Diseases, 167 North Lishi Road, Xicheng District, Beijing, 10037, China. ffouyang@yahoo.com.
Abstract
OBJECTIVES: We aimed to describe the feasibility of a surgical left thoracotomy for catheter ablation of scar-related ventricular tachycardia (VT) in patients with inaccessible pericardial access. BACKGROUND: Pericardial adhesion due to prior cardiac surgery or previous epicardial ablation procedures limits epicardial access in patients with drug-refractory VT originated from the epicardium. METHODS: Six patients who underwent a surgical left lateral thoracotomy epicardial access for catheter ablation of VT after failed subxiphoid percutaneous epicardial access were reviewed. Patients' baseline characteristics and procedural characteristics including epicardial access, mapping, and ablation were described. Epicardial access was successfully obtained in all patients by a surgical left lateral thoracotomy. RESULTS: The reasons of pericardial adhesion were prior cardiac surgery (n = 3, 50%) and previous epicardial ablation procedures (n = 3, 50%). Epicardial mapping of the lateral and inferior left ventricle was acquired, and a total of 15 different VTs originated from those regions were abolished. Unless one patient with ST elevation myocardial infarction due to periprocedural occlusion of the posterior descending artery no further complications occurred. All patients were discharged 10.2 ± 4 days after the procedure. VT recurred in 1 patient (17%) and was controlled with oral amiodarone therapy during follow-up (median follow-up: 479 days). CONCLUSIONS: A surgical left lateral thoracotomy is feasible and safe for selected patients. This approach provides epicardial ablation in patients with VT located at the infero-lateral left ventricle and pericardial adhesions due to previous cardiac surgery or previous ablation procedures.
OBJECTIVES: We aimed to describe the feasibility of a surgical left thoracotomy for catheter ablation of scar-related ventricular tachycardia (VT) in patients with inaccessible pericardial access. BACKGROUND: Pericardial adhesion due to prior cardiac surgery or previous epicardial ablation procedures limits epicardial access in patients with drug-refractory VT originated from the epicardium. METHODS: Six patients who underwent a surgical left lateral thoracotomy epicardial access for catheter ablation of VT after failed subxiphoid percutaneous epicardial access were reviewed. Patients' baseline characteristics and procedural characteristics including epicardial access, mapping, and ablation were described. Epicardial access was successfully obtained in all patients by a surgical left lateral thoracotomy. RESULTS: The reasons of pericardial adhesion were prior cardiac surgery (n = 3, 50%) and previous epicardial ablation procedures (n = 3, 50%). Epicardial mapping of the lateral and inferior left ventricle was acquired, and a total of 15 different VTs originated from those regions were abolished. Unless one patient with ST elevation myocardial infarction due to periprocedural occlusion of the posterior descending artery no further complications occurred. All patients were discharged 10.2 ± 4 days after the procedure. VT recurred in 1 patient (17%) and was controlled with oral amiodarone therapy during follow-up (median follow-up: 479 days). CONCLUSIONS: A surgical left lateral thoracotomy is feasible and safe for selected patients. This approach provides epicardial ablation in patients with VT located at the infero-lateral left ventricle and pericardial adhesions due to previous cardiac surgery or previous ablation procedures.
Authors: Daniele Muser; Pasquale Santangeli; Simon A Castro; Rajeev K Pathak; Jackson J Liang; Tatsuya Hayashi; Silvia Magnani; Fermin C Garcia; Mathew D Hutchinson; Gregory G Supple; David S Frankel; Michael P Riley; David Lin; Robert D Schaller; Sanjay Dixit; Erica S Zado; David J Callans; Francis E Marchlinski Journal: Circ Arrhythm Electrophysiol Date: 2016-10
Authors: Christian Sohns; Henrik Fox; Leonard Bergau; Philipp Sommer; Mustapha El Hamriti; Michel Morshuis; Denise Guckel; René Schramm; Sebastian V Rojas; Guram Imnadze; Jan F Gummert Journal: Clin Res Cardiol Date: 2021-10-28 Impact factor: 5.460