Percutaneous epicardial radiofrequency ablation of ventricular arrhythmias after failure of endocardial approach: a 9-year experience.

Introduction: Management of recurrent ventricular tachycardia (VT) remains difficult. Neither medical treatments nor conventional endocardial radiofrequency (RF) ablation are efficient to prevent some recurrences. In these cases, a percutaneous pericardial approach may be required.

Methods: Among all the patients referred to our center between 1998 and 2007 for a VT ablation, 276 endocardial and 35 epicardial procedures were performed, the latter in case of failure of the conventional approach. We report in this study the efficacy and the safety of these 35 interventions analyzed retrospectively.

Results: Thirty-five epicardial procedures were attempted in 32 patients. An electric storm was present in 5 of 32 (16%) patients, with other individuals presenting with a recurrent VT despite drug therapy and a previous endocardial ablation. Pericardial space was reached in 28 of 32 patients by a xyphoidian puncture. An immediate success of RF on clinical VT was obtained in 22 of 29 (76%) cases. During a mean follow-up of 384 +/- 405 days, only 9 patients (26%) experienced a recurrence of a sustained VT. One patient died from tamponade during the procedure despite surgical drainage. Other complications had no significant consequences.

Conclusion: Percutaneous epicardial puncture is feasible and relatively safe in patients with recurrent VT in whom conventional endocardial RF ablation failed. Epicardial RF ablation offers a high success rate in these challenging patients with only few severe complications.