Percutaneous epicardial ablation of ventricular tachycardia after failure of endocardial approach in the pediatric population with arrhythmogenic right ventricular dysplasia

Background Despite the high efficacy of catheter ablation of ventricular tachycardia (VT) in patients with arrhythmogenic right ventricular dysplasia (ARVD), in some patients, conventional endocardial ablation is ineffective. These failures could be explained by the presence of epicardial arrhythmogenic substrate. In these cases, a percutaneous epicardial ablation may be required. Objective This study sought to report the feasibility and results of epicardial VT ablation in a pediatric population of ARVD patients in whom endocardial ablation was unsuccessful. Methods Seventeen ARVD pediatric patients (mean age 14 ± 4 years) in whom a percutaneous epicardial radiofrequency ablation of VT was attempted were included in this retrospective analysis. A total of 20 mappable, hemodynamically stable, monomorphic VTs were induced (2 macroreentrant and 18 focal). All patients underwent right ventricular epicardial VT ablation. Results At the end of the procedure, 16 (94.1%) of the 17 patients had no inducible VT. Pericardial effusion occurred in 4 patients (23.5%), with 1 (5.9%) patient having tamponade that required percutaneous pericardial drainage. During a mean follow-up of 26 ± 15 (range 6 to 42) months, 12 (70.6%) patients remained free of any episodes of VT. All patients with successful RF ablation were free from any antiarrhythmic drugs. There were no deaths during the follow-up period. Recurrences of VT were recorded in 5 (29.4%) patients. Conclusion Percutaneous epicardial catheter ablation is feasible and relatively safe in pediatric ARVD patients with recurrent VT in whom conventional endocardial ablation failed.