Epicardial ablation of ventricular tachycardias: case report and literature review

█ Case Report

DOI: 10.26430/CHUNGARICA.2023.53.3.262

Authors:
Szilágyi Gergő, Csanádi Zoltán, Clemens Marcell
Debreceni Egyetem, Klinikai Központ, Kardiológiai és Szívsebészeti Klinika, Debrecen

Levelezési cím: Dr. Szilágyi Gergő, DEKK, Kardiológiai és Szívsebészeti Klinika
4032 Debrecen, Móricz Zsigmond krt. 22. E-mail: szilagyi.istvangergo@gmail.com

Summary
Ventricular tachycardias (VT) are common in different types of cardiomyopathies. Consequently, ICD implantation could be indicated as a primary or secondary prevention. However, in case of multiple VT episodes with ICD discharges despite antiarrhythmic medication, catheter ablation of the VT should be considered. Epicardial ablation of the VT could be a first line treatment, or used following an unsuccesful endocardial ablation.
A 48 year-old female patient with non-ischemic dilated cardiomyopathy (NICM) received a VVI ICD in a primary prevention indication. Amiodarone treatment due to numerous shock delivery for VT-s was only temporarily successful due to an electrical storm, and as a result endocardial catheter ablation was performed. At the end of the procedure the clinical VT could not be induced. Two months after the first procedure, the patient was readmitted to the Institute again due to another electric storm, amiodarone and mexiletin treatment was inefficient, hence after a combined endo-epicardial mapping an extensive epicardial scar was also found. After the ablation in this area no VT could be induced. During follow up, leaving the patient on oral amiodarone therapy, VT-s were rare, and, importantly, always were terminated by ATP.
According to recent studies, in certain cardiomyopathies-like NICM- the epicardial origin of VT-s is frequent. Therefore, epicardial ablation could be neccesary by alone or in conjunction with endocardial ablation. Multicenter studies proved that the success rate of epicardial ablation of VT-s is high in experienced centers and the incidence of complications is not higher than with the endocardial approach.

ISSUE: CARDIOLOGIA HUNGARICA | 2023 | VOLUME 53, ISSUE 3

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