Epicardial ablation of ventricular tachycardia: An institutional experience of safety and efficacy

Roderick Tung, Yoav Michowitz, Ricky Yu, Nilesh Mathuria, Marmar Vaseghi, Eric Buch, Jason Bradfield, Osamu Fujimura, Jean Gima, William Discepolo, Ravi Mandapati, Kalyanam Shivkumar

Research output: Contribution to journalArticlepeer-review

126 Scopus citations


Background: Epicardial ablation has been shown to be a useful adjunct for treatment of ventricular tachycardia (VT). Objective: To report the trends, safety, and efficacy of epicardial mapping and ablation at a single center over an 8-year period. Methods: Patients referred for VT ablation (June 2004 to July 2011) were divided into 3 groups: ischemic cardiomyopathy (ICM), nonischemic cardiomyopathy (NICM), and idiopathic ventricular arrhythmias (VA). Patients with scar-mediated VT who underwent combined epicardial and endocardial (epi-endo) mapping and ablation were compared with those who underwent endocardial-only (endo-only) ablation with regard to patient characteristics, acute procedural success, 6- and 12-month clinical outcomes. Results: Among 144 patients referred for VT ablation, 95 patients underwent 109 epicardial procedures (94% access rate). Major complications were seen in 8 patients (8.8%) with pericardial bleeding (>80 cm3) in 6 cases (6.7%), although no tamponade, surgical intervention, or procedural mortality was seen. Patients with ICM who underwent a combined epi-endo ablation had improved freedom from VT compared with those who underwent endo-only ablation at 12 months (85% vs 56%; P =.03). In patients with NICM, no differences were seen between those who underwent epi-endo ablation and those who underwent endo-only ablation at 12 months (36% vs 33%; P = 1.0). In idiopathic VA, only 2 of 17 patients were successfully ablated from the epicardium. Conclusions: In this large tertiary single-center experience, complication rates are acceptably low and improved clinical outcomes were associated with epi-endo ablation in patients with ICM. Patients with NICM represent a growing referred population, although clinical recurrence remains high despite epicardial ablation. Epicardial ablation has a low yield in idiopathic VA.

Original languageEnglish (US)
Pages (from-to)490-498
Number of pages9
JournalHeart Rhythm
Issue number4
StatePublished - Apr 2013


  • Ablation
  • Epicardial
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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