Parasternal intercostal approach as an alternative to subxiphoid approach for epicardial catheter ablation A case report》.pdfVIP

Parasternal intercostal approach as an alternative to subxiphoid approach for epicardial catheter ablation: A case report Koji Miyamoto, MD, Takashi Noda, MD, PhD, Takeshi Aiba, MD, PhD, Kengo Kusano, MD, PhD From the Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. Introduction requiring DC shock to terminate. Endocardial-only RFCA at The importance of an epicardial substrate for cardiac the left ventricle (LV) was performed in June 2014, but VT arrhythmias has been increasingly recognized. Combined could not be suppressed. He was referred to the National endocardial and epicardial mapping and radiofrequency Cerebral and Cardiovascular Center for electrophysiologic catheter ablation (RFCA) has become the standard strategy study and RFCA. His weight was 86 kg and height was 170 cm. for treatment of ventricular tachycardia (VT).1,2 The sub- His body mass index was 30, and his abdomen was protuberant. xiphoid approach is the standard and most frequently used Echocardiography revealed severely dilated and reduced LV method for percutaneous epicardial access.1,2 However, wall motion, with diastolic dimension of 73 mm and ejection complications of the subxiphoid approach are not uncom- fraction of 0.15. mon, even in experienced centers, with reported rates of 4% to 7%.3,4 In addition, obtaining epicardial access using the Epicardial approach subxiphoid approach may be difficult because of extracar- After obtaining written informed consent, electrophysiologic diac structures located on the epicardial needle trajectory. study and RFCA were performed with the patient under T