Epicardial mapping and ablation of cardiac arrhythmias

Abstract

Epicardial mapping and ablation of cardiac arrhythmias has been an important development in interventional electrophysiology. The fibrous and serous pericardia are separated by a space that permits introduction of a guide wire using a subxiphoid percutaneous approach. There are two major sinuses in the pericardial space. A sheath advanced over the guide wire provides a mean to introduce one or more catheters or probes to perform mapping and ablation epicardially. Atrial arrhythmias that require epicardial mapping and ablation include unusual types of atrial tachycardia or accessory pathways. In patients with atrial fibrillation or atypical atrial flutter, epicardial mapping and ablation may be required to obtain isolation or elimination of atrial substrate. In patients with ischemic heart disease and left ventricular dysfunction, as well as in patients with dilated cardiomyopathy, or with infiltrative or unusual forms of heart disease, ventricular tachycardia may originate epicardially or require epicardial mapping prior to performing endocardial ablation. There are numerous considerations requiring safety and management of patients undergoing epicardial mapping and ablation. Newer surgical and hybrid procedures, from the collaboration of electrophysiology and surgery, may also provide new approaches to performing interventional electrophysiology procedures that may require epicardial mapping and ablation.