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Epicardial Ventricular Tachycardia Ablation by Percutaneous Pericardial Puncture Running title : Treatment of ventricular tachycardia

This study aims to introduce epicardial ablation by percutaneous pericardial puncture in the treatment of ventricular tachycardia (VT). A female patient aged 45 years old with VT was enrolled in this study. Her electrocardiogram (ECG) showed a heart rate of 188 to 194 times/min with a wide QRS wave with upward dominant waves in leads I, II, III, aVF, V5, and V6. Results also showed evident incisures at the top of the R wave and a downward dominant wave in lead V1. Radiofrequency ablation by percutaneous pericardial puncture under the guidance of Carto mapping system was also performed. Conventional endocardial mapping detected the earliest activation on the right free ventricular wall. The local activation time (LAT) was 96 ms earlier than the QRS wave in lead V1 in the surface ECG, where the pacing of QRS wave from the large end is similar to the surface ECG at attacking time. Repeated discharge from the large end with cold saline (35 W to 40 W, 40 °C to 50 °C) could not cease VT. Percutaneous pericardial puncture was conducted under X-ray fluoroscopy. A 4 mm, magnetic-navigated, temperature-controlled large head was fed to the right epicardium through the pericardial cavity. LAT was 109 ms earlier than QRS wave in lead V1 in the surface ECG. After right coronary angiography, VT was ended by radiofrequency ablation under the condition of 40 W and 55 °C for 10 s, followed by consolidation discharge for 90 s. No recurrence of tachycardia was observed in the postoperative ECG after 18 months. Epicardial ablation by percutaneous pericardial puncture is an effective supplementary method for endocardial ablation. [Yuanfeng Zhou, Lang Hong, Linfeng Li, Yun Qiu, Menquan Hu. Epicardial Ventricular Tachycardia Ablation by Percutaneous Pericardial Puncture. Life Sci J 2014; 11(6):360-364]. (ISSN: 1097-8135). http://www.lifesciencesite.com. 50