Epicardial Ablation

What is Epicardial Ablation?

Epicardial ablation is a specialized procedure used to treat rhythm disturbances originating from the outside of the heart. It requires advanced experience. There are two layers of membrane around the heart, called the visceral pericardium and the parietal pericardium. Epicardial ablation is an ablation treatment performed between these two membrane layers.

Epicardial Ablation Risks?

Epicardial ablation requires advanced experience. Various complications may occur during needle insertion. These include

  • Liver
  • Heart
  • The artery on the left side of the bone in the middle wall of the chest called the sternum
  • Very, very rarely, the intestines may be damaged.

The rate of all these is around 1-2%.

However, this risk is very acceptable compared to the great benefit you can get from epicardial ablation.

After the areas causing arrhythmia are found by epicardial approach, these areas should be burned. During the procedure, the distance of the catheter to the coronary vessels supplying the heart should be carefully evaluated and the procedure should be performed at safe distances.

During epicardial ablation, some fluid is injected between the membranes. After the ablation treatment, the fluid between the membranes is removed. Steroids are injected between the membranes to prevent future adhesions. Finally, it is checked with echocardiography and the procedure is terminated.

How to enter the Epicardial Cavity?

The most commonly used method in epicardial ablation is to enter between two membrane layers with a special needle with a slightly J-shaped tip in angiography. In the angiography device, a small needle is inserted between these membrane layers under the guidance of the imaging method called scopy. Then a 2-3 mm thick plastic sheath is duly placed in this area. This procedure is performed under general anesthesia.

Sometimes the membranes may be adherent to each other and the needle may not be able to penetrate between the membranes. In this case, access can be achieved through surgery. After access is achieved, mapping and ablation is performed.

Needle access to the epicardial area during epicardial ablation
Needle access into the epicardial cavity

How is Epicardial Ablation Performed?

After gaining access to the epicardial region, catheters are advanced to the epicardial region. For example, let’s imagine that we are ablating for ventricular tachycardia.
In the arrhythmia called ventricular tachycardia, the diseased areas are not only located on the inside of the heart walls. They can also be inside or outside the wall. A catheter is used to map and identify the areas that may be causing the arrhythmia. These areas are then ablated. Before ablation, the coronary arteries are checked and if there is a safe distance, the ablation is started. In these patient areas, areas that may cause arrhythmia are completely burned.

Epicardial ablation
Epicardial ablation

In Which Heart Rhythm Disorders Is Epicardial Ablation Performed?

Epicardial ablation may be necessary in the following rhythm disorders

epicardial ablation can be performed.

Are There Long-Term Risks of Epicardial Ablation?

In the long term after epicardial ablation, these membrane layers may stick together in some patients. This does not cause any health problems in the patient. If adhesions form, it may become difficult to enter between the membranes or to move comfortably after entering between the membranes when intervention is required again in the future. Therefore, medication is administered after epicardial ablation to prevent adhesions.

Reference: Epicardial ablation of ventricular tachycardia

Update: February 3, 2024

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Picture of Prof. Dr. Taylan Akgün
Prof. Dr. Taylan Akgün

He is a cardiologist specialised in the diagnosis and treatment of heart rhythm problems (ablation), pacemaker procedures.
He works in Istanbul province.

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