ArticleClinical research in cardiology : official journal of the German Cardiac Society2025
Epicardial ventricular tachycardia ablation: safety and efficacy of access and ablation using low-iodine content.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Needle-in-needle micropuncture technique for epicardial access during ventricular tachycardia ablation.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Article
- Carbon Dioxide Insufflation for Assessment of Pericardial Adhesions and Informed Decision-Making for Percutaneous Epicardial Access in a Patient With Prior Cardiac Surgery.Journal of arrhythmia · 2026Article
- Nationwide Multicentric Analysis Regarding In-Hospital Complications After Catheter Ablation of Cardiac Arrhythmias.Journal of cardiovascular development and disease · 2026Article
- In-hospital outcomes of catheter ablation for ventricular tachycardia in patients with prior coronary artery bypass grafting.Heart rhythm O2 · 2026Article
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Abstract
backgroundEpicardial ablation has become an integral part of the treatment of ventricular tachycardias (VT). This study reports the safety of epicardial access as well as the efficacy of epicardial ablation of structural heart disease in a tertiary single-center experience.
methodsBetween January 2016 and February 2022, consecutive patients undergoing an epicardial access for VT ablation were included. Different puncture techniques and occurrence of epicardial access-related complications as well as the safety of ablation using non-ionic 5% dextrose in water (D5W) compared to standard 0.9% normal saline (NS) irrigation were analyzed. VT recurrence rates during a mean follow-up of 37 ± 23 months were reported.
resultsIn total, 197 patients undergoing a total of 239 procedures were included (59.8 ± 15.3 years, 86% males). A total of 154 patients (78%) had non-ischemic cardiomyopathies with a mean LVEF of 37 ± 14. Anterior-oriented epicardial access was aimed for in all cases and was successful in 217 (91%) of all procedures, whereas access was achieved in 19 procedures (8%) only using an inferior oriented access and in three procedures (1%) using surgical access due to severe adhesions or anatomical requirements. Overall epicardial puncture-related complications occurred in 18 (8%) of all procedures with minor pericardial bleeding in nine, pericardial tamponade in one, pneumothorax in five, pneumopericardium in one, and abdominal puncture in two cases. Presence of adhesions could be identified as the only independent predictor of epicardial access-related complications. D5W was used in 79 cases and regular 0.9% saline in 117 procedures. No differences were seen regarding acute ablation success or complications. During follow-up, 47% of all patients were free from any VTs (56% D5W vs. 40% NS; log-rank p = 0.747) and 92% of clinical VTs (98% D5W vs. 91% NS; log-rank p = 0.139).
conclusionsIn this large single-centre experience, epicardial access and ablation were safe and feasible. Although long-term clinical VT recurrence rates were low, overall VT recurrences as well as mortality were high advocating for a highly experienced, interdisciplinary approach including intense management of underlying cardiac disease/heart failure. Routine usage of D5W was safe and associated with comparable short- or long-term clinical or overall VT freedom.
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