How to approach epicardial ventricular tachycardia: electroanatomical mapping and ablation by transpericardial nonsurgical approach

Epicardial ablation of ventricular tachycardia in a child on venoarterial extracorporeal membrane oxygenation

Epicardial catheter ablation has been demonstrated to be safe and effective in adults, but there are limited reports in the pediatric population. We report the epicardial ablation of an incessant, hemodynamically compromising ventricular tachycardia in a 13-month-old patient on venoarterial extracorporeal membrane oxygenation. The procedure resulted in elimination of tachycardia substrate with improved cardiac size and function at follow-up. Despite a reasonable long-term outcome in this child, epicardial ablation in young patients should be reserved for similarly dire circumstances.

Percutaneous epicardial ablation reverses ventricular tachycardia mediated cardiomyopathy

We report on the case of an 18-year-old girl with asymptomatic incessant ventricular tachycardia. Initial attempts at endocardial ablation failed and she was monitored until her cardiac function deteriorated. A percutaneous epicardial approach with electroanatomical mapping was then used which successfully terminated the tachycardia. Left ventricular size and function subsequently returned to normal. This case demonstrates that percutaneous epicardial ablation of ventricular tachycardia is safe and feasible in young patients and highlights the importance of recognising this at an early stage.

Epicardial catheter ablation of ventricular tachycardia using surgical subxyphoid approach

We report the case of a patient presenting with a previous inferior myocardial infarction complicated by incessant monomorphic ventricular tachycardia resistant to antiarrhythmic drugs. Because endocardial catheter ablation failed and because of focal endocardial activation arising from the left ventricular inferior wall, an epicardial location of the reentry circuit was suspected. Catheter mapping of the pericardial space through a surgical subxyphoid approach performed in the electrophysiological laboratory confirmed the epicardial location of the arrhythmogenic substrate and allowed us successfully to ablate and cure the patient. Surgical subxyphoid approach can be performed in the electrophysiological laboratory when epicardial ablation is needed in case of inadvisable, difficult, or failed non-surgical percutaneous access.

Epicardial ablation of syncopal ventricular tachycardia. Utility of the electrocardiogram

We describe the case of a young man with syncopal ventricular tachycardia, normal left ventricular ejection fraction, normal coronary arteries, and a left ventricular aneurysm. The ECG during tachycardia suggested an epicardial origin. The arrhythmia was successfully treated using a non-surgical transthoracic epicardial approach.