ABSTRACT
Background: Combination of endocardial and epicardial approach
has improved the overall success rate of ventricular tachycardia (VT)
ablation in patients with cardiomyopathy. However, the origins of some
VTs are truly intramural or close to coronary arteries, which make this
combined strategy either prone to failure or too risky.
Objectives : This observational study aimed to explore the
feasibility and efficacy of direct epicardial ablation combined with
intramural ethanol injection via surgical approach for such VTs.
Methods: Six consecutive patients with recurrent sustained VT
refractory to combined endocardial and epicardial radiofrequency
ablation were included. Direct epicardial access was achieved through
limited left thoracotomy in 3 patients and median sternotomy in other 3
patients. Ablation was performed using irrigation catheter guided by
electroanatomic mapping. Ethanol was injected in all patients to
reinforce transmural lesions. The primary outcome was freedom of
sustained VT determined by device interrogation and periodical
24h-holter recordings subsequently.
Results: Over a median follow-up of 22 months (range,
6~65), all patients remained free of sustained VT. One
patient died of pulmonary infection one year after the procedure.
Conclusions: A hybrid strategy of surgical ablation combined
with intramural ethanol injection is feasible and effective in patients
with multiple failed percutaneous ablation attempts.
KEY WORDS: ventricular tachycardia, epicardial ablation,
ethanol injection, chemical ablation