4 years ago

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

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 in patients without prior cardiac surgery or pericarditis and explore their impact. 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 2004-2016, successful epicardial entry was achieved in 188/192 (98%) attempts. In 155 first time epicardial access attempts, pericardial adhesions were diagnosed in 13 (8%). When comparing baseline demographics, there were no significant differences. However, adhesions tended to occur more frequently with severe renal impairment (2% vs. 15%, p=0.07). No patients with structurally normal hearts had adhesions present. Adhesions were associated with limited epicardial mapping (3% vs. 85%, p<0.001) and lower acute procedural success (68% vs. 46%, p=0.02), but complication rates were similar. The presence of adhesions did not translate into lower VT free survival (p=0.64) or freedom from a combined end-point of VT recurrence, death or transplant at 1 year (p=0.93). Conclusion Adhesions can be unexpectedly encountered in patients without prior cardiac surgery or pericarditis. When present, they can limit mapping and may associate with lower acute success. Larger studies are required to determine their impact on long-term outcomes.

Publisher URL: www.sciencedirect.com/science

DOI: S154752711731086X

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