Safety and Efficacy of Epicardial Ablation of Ventricular Tachyarrhythmias: Experience from a Tertiary Referral Center in Taiwan.

Background: Epicardial catheter ablation has been shown to be an effective strategy for treating ventricular arrhythmias (VA). We investigated the efficacy and safety from a tertiary referral center in Taiwan.

Methods: From 2010 to 2016, patients undergoing epicardial ablation for VAs were consecutively enrolled. The clinical characteristics, disease entity, electrophysiological studies, and ablation outcome were extracted for further analysis.

Results: A total of 80 patients were eligible, including 34 patients for arrhythmogenic right ventricular cardiomyopathy (ARVC), 16 for Brugada syndrome (BrS), 13 for idiopathic VAs, 11 for idiopathic dilated cardiomyopathy (IDCM), 2 for ischemic cardiomyopathy, and 4 for other nonischemic cardiomyopathies (NICM). Epicardial ablation rendering VAs non-inducible was achieved in 78 patients (97.5%). There were no procedure-related deaths. Major complications were reported in 8 (10.0%) patients, including an acute hemopericardium in 5 (6.3%), delayed tamponade in 1 (1.3%), hemothorax in 1 (1.3%), and major pericardial reaction in 1 (1.3%). Two (2.7%) patients died due to causes other than procedure-related deaths. After a mean follow-up of 31 ± 15 months, 20 patients (25.0%) presented with VA recurrences, including 13 with ARVC, 1 with BrS, 1 with idiopathic VAs, 4 with IDCM, and 1 with other NICM.

Conclusions: In this tertiary referral center's experience, the complication rate of an epicardial approach was acceptable. Patients with NICM displayed a growing trend for a referral for epicardial ablation. The long-term follow-up demonstrated that an epicardial ablation for idiopathic VAs and BrS was associated with a better prognosis than that for the other etiologies.