Epicardial ablation is an intervention performed from the outer surface of your heart. Normally, ablation procedures are performed from the inner surface of your heart (endocardium). However, the source of some arrhythmias is located on the outer surface of your heart, and in these cases, epicardial ablation becomes necessary. This method is a technique applied especially in serious arrhythmias such as ventricular tachycardia that cannot be treated with other ablation techniques or that recur.
What Is Epicardial Ablation?
Epicardial ablation is a procedure applied to stop electrical signals causing abnormal heart rhythm through the epicardium, which is the outer membrane of the heart. Special catheters are placed through a small incision into the outer layer of the pericardium, which is a two-layered membrane surrounding your heart. These catheters detect the area causing arrhythmia and destroy abnormal electrical activity by burning that area.
Why Is Epicardial Ablation Performed?
The reasons for performing epicardial ablation are:
- Ventricular Tachycardia (VT): Especially in individuals with structural heart disease, in ventricular tachycardias that occur after heart attack, heart failure, or other heart diseases, there is a high probability that the abnormal focus is on the outer surface of the heart.
- Failure of Standard Ablation: When the focus causing rhythm disorder cannot be reached with ablation performed from inside your heart, or when arrhythmia recurs after the procedure, epicardial ablation is considered as the next option.
- Atrial Fibrillation (AF): In some atrial fibrillation cases, especially when there are triggers originating from the outer surface of the left atrium, epicardial ablation can be applied alone or together with endocardial ablation.
How Is Epicardial Ablation Performed?
Epicardial ablation is a procedure performed under operating room conditions, in a sterile environment, and under general anesthesia. During the procedure, the patient is anesthetized and a guide catheter is placed through a small incision made from the chest or abdominal area with the help of a special needle to reach the outer surface of the heart. This catheter reaches the pericardium, which is the outer membrane of the heart, and is directed to the area causing the rhythm disorder.
The procedure steps are:
- Preparation: The patient is given general anesthesia and connected to monitors to monitor vital signs such as ECG and blood pressure.
- Access: Entry is usually made with a small needle from below the chest cage or from the abdominal area. This needle is directed to reach the pericardial space around the heart.
- Catheter Placement: A guide wire and then an ablation catheter are placed into this space through the needle.
- Mapping: The electrophysiologist (rhythm specialist) performs special mapping with this catheter to find the source of abnormal electrical activity on the outer surface of the heart.
- Ablation Application: When the arrhythmia source is found, radiofrequency energy (heat) is sent from the catheter to destroy the abnormal tissue in that area.
- End of Procedure: After successful ablation, catheters are removed and the patient is taken to the intensive care unit for observation.
What Are the Benefits of Epicardial Ablation?
Epicardial ablation offers a permanent treatment option especially for serious and life-threatening arrhythmias such as ventricular tachycardia. It significantly increases the success rate in cases where standard ablation is insufficient. Successful epicardial ablation improves patients’ quality of life, reduces medication dependence, and decreases the risk of sudden cardiac death.
What Are the Risks of Epicardial Ablation?
Like any surgical procedure, epicardial ablation also carries some risks. However, these risks are generally minimal in experienced centers and expert hands. The most important risks include damage to the outer membrane of the heart (pericardial effusion), vascular or nerve injuries, and bleeding during the procedure.
The main risks of epicardial ablation are:
- Pericardial Effusion or Tamponade: During the procedure, damage to the outer membrane of the heart (pericard) may cause fluid or blood accumulation (effusion) in this area. Very rarely, this fluid accumulation can compress the heart and cause life-threatening situations (tamponade).
- Vascular or Nerve Injuries: Damage may occur in the vascular areas where catheters are placed or in nerves passing around the heart (such as the phrenic nerve).
- Infection and Bleeding: As with any invasive procedure, there is a risk of infection or bleeding at entry sites.
- Stroke: Although very rare, clots formed during the procedure going to the brain can cause stroke risk.
Conclusion: Is Epicardial Ablation the Right Choice for You?
Epicardial ablation is an extremely effective and important treatment method especially for serious arrhythmias that cannot be treated with standard ablation or originating from the outer surface of the heart. If ablation was previously performed for your rhythm disorder but no results were obtained, or if your doctor thinks that the abnormal focus is on the outer surface of your heart, epicardial ablation may be the right option for you. When making this decision, you should discuss all aspects of your disease and risks in detail with a specialist electrophysiologist. This way, you can determine the most appropriate treatment plan for you.
