P295Safety of epicardial ablation of ventricular tachykardia: A large single center experience

Abstract

Background: Te presence of transmural or epicardial substrate in patients with ventricular tachycardia often requires epicardial access to achieve successful ablation. In previous studies a complication rate up to 20% is reported. In two large multicenter studies major complication rates of 4.1% and 5.0% have been reported. Methods: 190 patients (109 male, mean age 54) receiving 216 epicardial VT-ablations between 2008 and 2015 were included in this investigation. Te underlying structural heart diseases were ischemic cardiomyopathy (n = 29), arrhythmogenic right ventricular cardiomyopathy (n = 17), and non-ischemic cardio-myopathy (n = 144). Results: Epicardial access was obtained via subxyphoi-dal puncture in 208 procedures, fve of them with double percutaneous epicardial access, and via surgical approach in 6 patients. Re-ablation was required in 28 (14.7%) patients. Te epicardium could not be accessed in 2 procedures. Among 190 patients receiving epicardial ablation major complications were seen in 2 patients with myocardial perforation requiring emergency cardiac surgery. No patient died due to procedure related complications. Tree patients had minor pericardial bleeding after procedure requiring draining with a pigtail catheter. One patient developed a femoral aneurysm and had to undergo vascular surgery. No coronary artery or phrenic nerve injury were observed. Conclusions: Epicardial ablation in high volume center performed by experienced operators has a low complication (2.7%) and mortality (0.0%) rates.