Incidence and significance of adhesions encountered during epicardial mapping and ablation of ventricular tachycardia in patients with no history of prior cardiac surgery or pericarditis.

BACKGROUND: Pericardial adhesions can prevent epicardial access and restrict catheter movement during mapping and ablation of ventricular tachycardia (VT). The incidence of adhesions in patients without prior cardiac surgery or clinically evident pericarditis is not known.

OBJECTIVE: To describe the incidence of pericardial adhesions and explore their impact in patients without prior cardiac surgery or pericarditis.

METHODS: A retrospective search of our ablation database containing patients who underwent epicardial ablation for VT was undertaken. Adhesions were diagnosed with routine contrast pericardiography after pericardial entry. Demographics and long-term outcomes were compared between patients with and without adhesions.

RESULTS: Between 2004 and 2016, successful epicardial entry was achieved in 188 of 192 attempts (98%). In 155 first-time epicardial access attempts, pericardial adhesions were diagnosed in 13 (8%). When comparing baseline demographics, there was no significant difference. However, adhesions tended to occur more frequently with severe renal impairment (2% of patients without adhesions vs 15% of patients with adhesions, P = .07). No patient with a structurally normal heart had adhesions present. Adhesions were associated with limited epicardial mapping (3% of patients without adhesions vs 85% of patients with adhesions, P < .001) and lower short-term procedural success (68% of patients without adhesions vs 46% of patients with adhesions, P = .02), but complication rates were similar. The presence of adhesions did not translate into lower VT-free survival (P = .64) or freedom from a combined end point of VT recurrence, death, or transplant at 1 year (P = .93).

CONCLUSION: Adhesions may be unexpectedly encountered in patients without prior cardiac surgery or pericarditis. When present, they can limit mapping and may be associated with lower short-term success. Larger studies are required to determine their impact on long-term outcomes.