Safety and Efficacy of Epicardial Ablation of Ventricular Tachyarrhythmias: Experience from a Tertiary Referral Center in Taiwan.

BACKGROUND

Epicardial catheter ablation has been shown to be an effective strategy for treating ventricular arrhythmias (VA). We investigated the efficacy and safety from a tertiary referral center in Taiwan.

METHODS

From 2010 to 2016, patients undergoing epicardial ablation for VAs were consecutively enrolled. The clinical characteristics, disease entity, electrophysiological studies, and ablation outcome were extracted for further analysis.

RESULTS

A total of 80 patients were eligible, including 34 patients for arrhythmogenic right ventricular cardiomyopathy (ARVC), 16 for Brugada syndrome (BrS), 13 for idiopathic VAs, 11 for idiopathic dilated cardiomyopathy (IDCM), 2 for ischemic cardiomyopathy, and 4 for other nonischemic cardiomyopathies (NICM). Epicardial ablation rendering VAs non-inducible was achieved in 78 patients (97.5%). There were no procedure-related deaths. Major complications were reported in 8 (10.0%) patients, including an acute hemopericardium in 5 (6.3%), delayed tamponade in 1 (1.3%), hemothorax in 1 (1.3%), and major pericardial reaction in 1 (1.3%). Two (2.7%) patients died due to causes other than procedure-related deaths. After a mean follow-up of 31 ± 15 months, 20 patients (25.0%) presented with VA recurrences, including 13 with ARVC, 1 with BrS, 1 with idiopathic VAs, 4 with IDCM, and 1 with other NICM.

CONCLUSIONS

In this tertiary referral center's experience, the complication rate of an epicardial approach was acceptable. Patients with NICM displayed a growing trend for a referral for epicardial ablation. The long-term follow-up demonstrated that an epicardial ablation for idiopathic VAs and BrS was associated with a better prognosis than that for the other etiologies.