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Epicardial Ablation of Ventricular Tachycardia: a Review

For over 3 decades, it has been known that reentry circuits for ventricular tachycardia (VT) are not limited to the subendocardial myocardium. Rather, intramural or subepicardial substrates may also give rise to VT, particularly in those with non-ischemic cardiomyopathy. Percutaneous epicardial mapp...

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Detalles Bibliográficos
Autores principales: Cardoso, Rhanderson, Aryana, Arash, Singh, Sheldon M., Tandri, Harikrishna, d'Avila, Andre
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society of Cardiology 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110707/
https://www.ncbi.nlm.nih.gov/pubmed/30088360
http://dx.doi.org/10.4070/kcj.2018.0210
Descripción
Sumario:For over 3 decades, it has been known that reentry circuits for ventricular tachycardia (VT) are not limited to the subendocardial myocardium. Rather, intramural or subepicardial substrates may also give rise to VT, particularly in those with non-ischemic cardiomyopathy. Percutaneous epicardial mapping and ablation has been successfully introduced for the treatment of such subepicardial VT. Herein, we review the indications for epicardial ablation and the identification of epicardial VT by electrocardiographic and imaging modalities. We also discuss the optimal technique for epicardial access and the implications of epicardial fat which has the potential to mimic scar, decreasing the specificity of electrogram morphology and impeding energy delivery to the tissue. Finally, we also report on possible complications of the procedure and strategies to mitigate adverse events.