Ene Elena, Didenko Maxim, Berkovitz Artur, Nentwich Karin, Sonne Kai, Zhuravlev Vitali, Deneke Thomas
Klinik für Kardiologie II - Rhythmologie und interventionelle Elektrophysiologie, Rhön Klinikum AG Campus Bad Neustadt, Bad Neustadt, Deutschland.
Chirurgische und interventionelle Rhythmologie Abteilung, Kupriyanov Kardiochirurgie Abteilung der Medizinischen Militärakademie, Saint-Petersburg, Russland.
Herzschrittmacherther Elektrophysiol. 2022 Jun;33(2):175-180. doi: 10.1007/s00399-022-00856-w. Epub 2022 May 13.
The arrhythmogenic substrate in patients with Chagas cardiomyopathy, arrhythmogenic dysplasia, postmyocarditis nonischemic dilative cardiomyopathy as well as after extensive posterior or anterior wall myocardial infarction is predominantly located epicardially. This can necessitate epicardial access for an effective, substrate-based catheter ablation of the ventricular tachycardia (VT). Anterior percutaneous epicardial puncture represents the standard approach for epicardial VT ablation. The most important anatomical particularities that must be taken into account when performing an epicardial puncture or epicardial VT ablation are epicardial coronary arteries, left phrenic nerve and epicardial fat. The typical anatomic characteristics of the epicardial structures and resulting considerations for epicardial access are discussed here in detail.
