RESUMEN
INTRODUCTION: Multielectrode mapping catheters (MEMC) allow the performance of high resolution and density maps but the utility of these catheters in ventricular tachycardia (VT) ablation procedures has not been yet widely described. We sought to evaluate the utility of a MEMC during scar-related VT ablation procedures. METHODS: Eighty-five consecutive scar-related VT ablation procedures were performed in 81 patients. In the first 26 procedures, a standard 3.5-mm tip linear catheter was employed for endocardial/epicardial mapping (control group). In the following 59 procedures mapping was performed with a MEMC (study group). Procedural time, LV endocardial and epicardial mapping time, complications and ablation outcomes were compared. RESULTS: The use of the MEMC resulted in a significant shortening of the endocardial and epicardial mapping times (38 ± 15 minutes vs. 56 ± 24 minutes for endocardial LV mapping in the study and control group, respectively, P = 0.001; and 28 ± 9 minutes vs 41 ± 16 minutes, for epicardial mapping, P = 0.011) as well as the total procedural time (177 ± 53 minutes vs. 206 ± 50 minutes, respectively, P = 0.02). The mapping density was also significantly increased in the study group (mean endocardial LV points: 2,143 ± 1,419 vs. 485 ± 174, for the study and control group, respectively, P < 0.0001), specially within the scar area (49.6 ± 34 points/cm2 vs. 8.4 ± 4.6 points/cm2 , P < 0.001). No differences in acute and long-term follow-up outcomes were observed. CONCLUSIONS: High-density multielectrode mapping is associated with a significant reduction of procedural and mapping times and a significant increase of mapping density without affecting outcomes in patients with scar-related VT.
Asunto(s)
Cicatriz/diagnóstico por imagen , Cicatriz/fisiopatología , Mapeo Epicárdico/estadística & datos numéricos , Mapeo Epicárdico/tendencias , Taquicardia Ventricular/diagnóstico por imagen , Taquicardia Ventricular/fisiopatología , Anciano , Ablación por Catéter/tendencias , Cicatriz/cirugía , Electrodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Taquicardia Ventricular/cirugíaRESUMEN
INTRODUCTION: Epicardial access (EpiAcc) has become an important adjunct for ventricular tachycardia (VT) or premature ventricular complex (PVC) ablation. We hypothesized that post-procedural pericarditis may lead to an increased risk of atrial fibrillation (AF), and therefore assessed the incidence and clinical impact of post-procedural AF in patients undergoing EpiAcc. METHODS: We reviewed the records of all patients who underwent EpiAcc as part of an ablation procedure between January 1, 2004 and July 31, 2014 at Mayo Clinic Rochester. AF occurrence was determined by clinical documentation or electrocardiographic recordings post procedure. RESULTS: Epicardial access was obtained in 170 pts (indication 110 VT and 60 PVC). The mean age was 53 ± 16 years and 122 (72%) were male. Seven (4.1%) patients developed AF within 7 days of the procedure, at a mean of 49 ± 18 h post procedure; it was paroxysmal in all patients with an average duration 6.0 ± 5.5 h (range 2-18). All patients spontaneously converted to sinus rhythm; but 3 needed rate control with AV nodal blockade (calcium channel blockers [n = 2] or beta blockers [n = 1]). One patient out of 60 who received intrapericardial steroids developed AF (2%), while of the 110 who did not receive steroids, 6 developed AF (5%) (p = 0.42). During average follow-up 2.3 years, there were no documented recurrences of atrial fibrillation in these patients. CONCLUSION: Atrial fibrillation following epicardial access is infrequent. When it occurs, it tends to be paroxysmal in nature and without severe symptoms. Administration of intrapericardial steroids did not affect the rate of AF post procedure; further studies however are needed to define their role.
Asunto(s)
Fibrilación Atrial/diagnóstico , Fibrilación Atrial/epidemiología , Ablación por Catéter/estadística & datos numéricos , Mapeo Epicárdico/estadística & datos numéricos , Pericardio/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Causalidad , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Minnesota/epidemiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
PURPOSE: Percutaneous pericardial access (EpiAcc) assists ventricular tachycardia/premature ventricular complex (VT/PVC) ablation by permitting epicardial mapping and ablation outside the vicinity of the coronary venous system. We sought to determine whether expanding indications and growing operator experience have led to increased rates of EpiAcc. METHODS: We reviewed the frequency of EpiAcc procedures performed during VT/PVC ablation between 2007 and 2014 to identify temporal trends in the procedure. RESULTS: There were 758 patients undergoing 880 VT/PVC ablation procedures (average 95 patients per year; 110 procedures per year) during the study period. EpiAcc for ablation was utilized in 170 patients (181 procedures). The average age at the time of EpiAcc was 55 ± 16 years and 129 (76.0 %) patients were male. The rate of EpiAcc was 22.9 % in males and 15.4 % in females (P = 0.008). The absolute number of EpiAcc procedures increased from 2007 (6 procedures) to 2014 (27 procedures). Similarly, the proportion of patients undergoing EpiAcc increased from 8.6 % of procedures in 2007 to 24.5 % in 2014 (P < 0.0001). While EpiAcc use became more frequent, the rate of epicardial ablation among those who underwent EpiAcc remained stable (approximately 70 %). CONCLUSIONS: Percutaneous pericardial access has been used with increasing frequency as part of VT/PVC ablations without an increase in the rate of epicardial ablation. This growing utilization may lay the foundation for novel epicardial strategies as new technologies emerge. The frequency of percutaneous pericardial access in VT/PVC ablation appears to be greater in males, reasons for which are undefined.