Hybrid epicardial ventricular tachycardia ablation with lateral thoracotomy in a patient with a history of left ventricular reconstruction surgery

Abstract

Although a hybrid procedure involving surgical access may be feasible for epicardial catheter ablation in individuals with prior cardiac surgery, surgical approaches in thoracotomy are important in patients with advanced adhesions. We performed an epicardial ventricular tachycardia (VT) ablation in a patient with dilated phase hypertrophic cardiomyopathy after left ventricular reconstruction. We gained surgical epicardial access via lateral thoracotomy based on the anticipated VT circuit in the apical anteroseptal area, which was estimated using prior endocardial mapping. The remaining epicardial myocardium around the surgical incision was involved in the central isthmus, and the VT was eliminated by radiofrequency catheter ablation. <Learning objective: Postoperative adhesions hampered the percutaneous catheter approach by subxiphoid puncture in patients with a history of cardiac surgery. Combining anatomical consideration by computed tomography imaging and information from endocardial ablation helped to perform a minimally invasive surgical epicardial approach. The remaining epicardial myocardium around the surgical incision was assumed to be involved in the reentry circuit of the ventricular tachycardia in a patient diagnosed with dilated-phase hypertrophic cardiomyopathy with a previous history of left ventricular reconstruction.>.

Keywords: Dilated phase hypertrophic cardiomyopathy; Epicardial catheter ablation; Left ventricular reconstruction; Non-ischemic cardiomyopathy; Ventricular tachycardia.