Introduction: One of the reasons for failure of failure of idiopathic ventricular arrhythmias ablation is the epicardial origin of the arrhythmia. They can be reached by the epicardial venous system, but sometimes the percutaneous subxyphoid mapping is necessary.
Methods: Between 2007 and 2015, nine patients (7 men, median age 32.0 – range 1-46 years-old) without heart disease were referred to our EP lab due to failure of previous intravascular approach for subxyphoid epicardial ablation of outflow tract ventricular arrhythmias.
Results: There was a median of 1 (range 0-3) previous intravascular ablation attempts. Epicardial subxyphoid ablation was successful in three patients (33%); in 4 an additional endocardial mapping was successful (1 RVOT, 1 LCC, 1 RCC and 1 LV infra-valvar). In one patient that epicardial subxyphoid ablation was successful had arrhythmia recurrence. In two patients there was earlier epicardial activation, but the spot was close to the coronary artery. There were 2 complications; one was transient ST segment elevation during ablation, with subsequent coronariography with no lesions and other patient presented hemopericardium with the need of open chest surgery, with complete recovery of the patient. One 1 year and 4 month children had failed epicardial ablation with a second endocardial successful ablation on the infero-basal region of the left ventricule.
Conclusions: Epicardial approach to ablate epicardial outflow tract ventricular arrhytmias is an alternative to eliminate when previous endocardial ablation failed in some patients.