SPC365

Epicardial mapping as first intention approach for structural ventricular tachycardia ablation

Session: Comunicações Orais (Sessão 1) - Arrítmias 1 - Taquicardia ventricular
Speaker: Catarina Gregório

Congress: CPC 2022
Topic: C. Arrhythmias and Device Therapy
Theme: 08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme: 08.4 Ventricular Arrhythmias and SCD - Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Catarina Gregório; Joana Brito; Pedro Silvério António; Sara Couto Pereira; Beatriz Valente Silva; Pedro Alves da Silva; Ana Beatriz Garcia; Ana Margarida Martins; Patrícia Teixeira; Afonso Nunes Ferreira; Gustavo Silva; Luís Carpinteiro; Nuno Cortez-Dias; Fausto j. Pinto; João de Sousa

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#2a2a2a"><strong>Introduction:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#2a2a2a"> </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#2a2a2a">In several structural arrhythmogenic diseases that comprise intricate endocardial, intramural and epicardial substrates, endocardial ablation of ventricular tachycardia (VT) is not sufficient and epicardial ablation has lately become a complementary and necessary tool.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#2a2a2a"><strong>Purpose: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#2a2a2a">To evaluate the clinical characteristics of patients (pts) most suitable for first intention epicardial VT ablation.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#2a2a2a"><strong>Methods:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#2a2a2a"> </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#2a2a2a">Single-center prospective study of consecutive pts with structural heart disease undergoing first intention epicardial VT mapping between August 2015 and June 2021. Decision for epicardial approach was based on the etiology, VT electrocardiogram (ECG) and cardiac magnetic resonance (CMR) results. Under general anesthesia, subxiphoid access using a Tuhoy needle was done using fluoroscopic guidance and with high-density epicardial mapping was performed. Epicardial ablation was performed if relevant arrhythmogenic findings were locally confirmed.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#2a2a2a"><strong>Results: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#2a2a2a">First intention epicardial VT ablation was attempted in 18 pts (mean age 59.8&plusmn;12 years,94% male) of whom 16 had non-ischemic dilated cardiomyopathy (NICM,idiopathic:11; post-myocarditis:4; hereditary:1) and 2 had right ventricular arrhythmogenic cardiomyopathy.</span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#2a2a2a"> </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#2a2a2a">Mean LVEF was 33% and 79% had a previous ICD (53% in primary prevention). 69% were referred for ablation due to arrhythmic storm (1pt in cardiogenic shock). Epicardial access was achieved in 17 pts (94%), without acute complications.</span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#2a2a2a"> </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#2a2a2a">In 35% pts with NICM the decision for epicardial approach was based on the detection of subepicardial CMR delayed-hyperenhancement and relevant epicardial arrhythmic substrate was confirmed by mapping in all cases.</span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#2a2a2a"> </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#2a2a2a">In 3 pts radiofrequency (RF) applications were not performed at epicardium, as no abnormal electrograms were locally detected, and an additional endocardial approach was prosecuted.</span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#2a2a2a"> </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#2a2a2a">The mean overall procedure and fluoroscopic time were 123 and 28 min, respectively, with a mean RF application time of 51 min.&nbsp;After the procedure, 1pt required pericardial drainage due to inflammatory pericardial effusion. No other acute complications occurred.</span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman'"><span style="color:#2a2a2a"> </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#2a2a2a">During a mean follow-up of 2.8&plusmn;1.8 years, only 3pts (17%) had VT recurrence;5pts (28%) died due to end-stage heart failure and 2pts (11%) underwent heart transplantation.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#2a2a2a"><strong>Conclusion: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#2a2a2a">In NICM a first intention epicardial VT ablation performed by experienced operators/centers is efficient, particularly if guided by CMR findings, and presents a favorable safety profile.</span></span></span></p>