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Surgical Ablation Supplemented by Ethanol Injection for Ventricular Tachycardia Refractory to Percutaneous ablation
  • +12
  • Gang Yang,
  • Yongfeng Shao,
  • Weidong Gu,
  • Buqing Ni,
  • Bing YANG,
  • Fengxiang Zhang,
  • Weizhu Ju,
  • Hongwu CHEN,
  • Kai Gu,
  • Mingfang Li,
  • yu CHEN,
  • Haoliang Sun,
  • tam_tsz_ kin,
  • Yanhu Wu,
  • Minglong Chen
Gang Yang
the First Affiliated Hospital of Nanjing Medical University
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Yongfeng Shao
The First Affiliated Hospital of Nanjing Medical University
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Weidong Gu
The First Affiliated Hospital of Nanjing Medical University
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Buqing Ni
The First Affiliated Hospital of Nanjing Medical University
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Bing YANG
Shanghai East Hospital
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Fengxiang Zhang
the First Affiliated Hospital of Nanjing Medical University
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Weizhu Ju
the First Affiliated Hospital of Nanjing Medical University
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Hongwu CHEN
the First Affiliated Hospital of Nanjing Medical University, Nanjing
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Kai Gu
Institution of Clinical cardiovascular center
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Mingfang Li
the First Affiliated Hospital of Nanjing Medical Universit
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yu CHEN
the First Affiliated Hospital of Nanjing Medical University
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Haoliang Sun
the First Affiliated Hospital of Nanjing Medical University
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tam_tsz_ kin
Division of Cardiology, Prince of Wales Hospital
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Yanhu Wu
the First Affiliated Hospital of Nanjing Medical University
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Minglong Chen
Institution of Clinical cardiovascular center
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Abstract

Background: Combination of endocardial and epicardial approach has improved the overall success rate of ventricular tachycardia (VT) ablation in patients with cardiomyopathy. However, the origins of some VTs are truly intramural or close to coronary arteries, which make this combined strategy either prone to failure or too risky. Objectives: This observational study aimed to explore the feasibility and efficacy of direct epicardial ablation combined with intramural ethanol injection via surgical approach for such VTs. Methods: Six consecutive patients with recurrent sustained VT refractory to combined endocardial and epicardial radiofrequency ablation were included. Direct epicardial access was achieved through limited left thoracotomy in 3 patients and median sternotomy in other 3 patients. Ablation was performed using irrigation catheter guided by electroanatomic mapping. Ethanol was injected in all patients to reinforce transmural lesions. The primary outcome was freedom of sustained VT determined by device interrogation and periodical 24h-holter recordings subsequently. Results: Over a median follow-up of 22 months (range, 6~65), all patients remained free of sustained VT. One patient died of pulmonary infection one year after the procedure. Conclusions: A hybrid strategy of surgical ablation combined with intramural ethanol injection is feasible and effective in patients with multiple failed percutaneous ablation attempts.

Peer review status:ACCEPTED

20 Nov 2020Submitted to Journal of Cardiovascular Electrophysiology
26 Nov 2020Submission Checks Completed
26 Nov 2020Assigned to Editor
27 Nov 2020Reviewer(s) Assigned
14 Dec 2020Review(s) Completed, Editorial Evaluation Pending
20 Dec 2020Editorial Decision: Revise Minor
06 Jan 20211st Revision Received
27 Jan 2021Assigned to Editor
27 Jan 2021Submission Checks Completed
27 Jan 2021Reviewer(s) Assigned
20 Mar 2021Review(s) Completed, Editorial Evaluation Pending
23 Mar 2021Editorial Decision: Revise Minor
02 Apr 20212nd Revision Received
05 Apr 2021Submission Checks Completed
05 Apr 2021Assigned to Editor
05 Apr 2021Reviewer(s) Assigned
12 May 2021Review(s) Completed, Editorial Evaluation Pending
17 May 2021Editorial Decision: Accept