44. Epicardial Mapping: Technique, Indication and Results

  1. Mohammad Shenasa MD2,
  2. Gerhard Hindricks MD3,
  3. Martin Borggrefe MD4,
  4. Günter Breithardt MD5 and
  5. Mark E. Josephson MD6
  1. Jeffrey R. Winterfield,
  2. Alexander Green,
  3. Peter Santucci,
  4. Smit Vasaiwala and
  5. David J. Wilber

Published Online: 18 DEC 2012

DOI: 10.1002/9781118481585.ch44

Cardiac Mapping, Fourth Edition

Cardiac Mapping, Fourth Edition

How to Cite

Winterfield, J. R., Green, A., Santucci, P., Vasaiwala, S. and Wilber, D. J. (2013) Epicardial Mapping: Technique, Indication and Results, in Cardiac Mapping, Fourth Edition (eds M. Shenasa, G. Hindricks, M. Borggrefe, G. Breithardt and M. E. Josephson), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118481585.ch44

Editor Information

  1. 2

    Attending Physician, Department of Cardiovascular Services, O'Connor Hospital, Heart & Rhythm Medical Group, San Jose, California, USA

  2. 3

    Professor of Medicine (Cardiology), University Leipzig, Heart Center, Director, Department of Electrophysiology, Leipzig, Germany

  3. 4

    Professor of Medicine (Cardiology), Head, Department of Cardiology, Angiology and Pneumology, University Medical Center, Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

  4. 5

    Professor Emeritus of Medicine and Cardiology, Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany

  5. 6

    Chief, Cardiovascular Medicine Division, Director, Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, Herman C. Dana Professor of Medicine, Harvard Medical School, Boston, Massachusetts, USA

Author Information

  1. Cardiovascular Institute, Loyola University Medical Center, Maywood, IL, USA

Publication History

  1. Published Online: 18 DEC 2012
  2. Published Print: 10 JAN 2013

ISBN Information

Print ISBN: 9780470670460

Online ISBN: 9781118481585

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Keywords:

  • epicardial mapping;
  • ventricular tachycardia;
  • non-ischemic cardiomyopathies;
  • myocardial infarction;
  • coronary venous mapping;
  • atrioventricular connections;
  • atrial fibrillation;
  • coronary venous mapping

Summary

Potential applications for epicardial mapping and ablation have expanded greatly over the past decade, particularly for treatment of ventricular tachycardia (VT). The frequency of epicardial sources of VT is greatest in patients with non-ischemic cardiomyopathies (25-50%), and less frequent in patients with prior myocardial infarction (10-15%) or without structural heart disease (10%). These frequencies help determine which patients should be considered for epicardial approaches, along with failure of prior endocardial ablation, or a suggestive ECG morphology. However, the predictive value of specific ECG features for epicardial VT is modest at best. Optimal techniques for percutaneous epicardial access and mapping, as well as coronary venous mapping, are reviewed. Epicardial VT ablation is associated with a 4-7% risk of major complications. However, accumulating evidence indicates that this approach can substantially improve rhythm control and long-term outcomes in patients with VT.