Catheter Ablation -> Ventricular Arrhythmias -> Ablation Techniques D-PO05 - Poster Session V (ID 39) Poster

D-PO05-183 - Needle Ablation Compared To Other Advanced Ablation Techniques For Failed Endocardial Ventricular Tachycardia Ablation (ID 584)


Background: Options when endocardial ventricular tachycardia (VT) ablation fails include epicardial, simultaneous unipolar (SURF) and transcoronary ethanol (TCE) ablation. Recently, investigational needle ablation has also been used, but how it compares to other advanced methods is not clear.
Objective: To compare outcomes and complications of patients with structural heart disease, VT, and failed endocardial ablation treated with needle ablation to those treated with other advanced ablation techniques.
Methods: We retrospectively reviewed 99 procedures in 94 consecutive patients with structural heart disease (excluding arrhythmogenic right ventricular cardiomyopathy) who failed endocardial ablation attempts and underwent ablation with either an investigational needle catheter or with other advanced techniques including epicardial, SURF or TCE ablation.
Results: Of 99 procedures, needle ablation was performed in 39 procedures. In the remaining 60 procedures, 57 were epicardial ablation including 7 with SURF ablation from endocardial and epicardial sites, two with SURF from both sides of the septum, one SURF and TCE ablation, and one TCE ablation (Table). Procedure time was shorter for needle ablation. There were 23 major complications observed in 23 procedures with pericardial bleeding occurring less frequently in needle ablation. Acute outcomes, 6-month VT recurrence, and mortality rates were similar between the two groups.
Conclusion: Ablation with an irrigated needle catheter compares favorably to other advanced ablation techniques, likely with less risk of pericardial bleeding than epicardial ablation. Continued study is warranted.