Publications

Lacus, ultrices in ultrices tellus odio nunc urna. Massa aenean sed ipsum praesent enim. Porttitor iaculis augue pulvinar nam feugiat. Aliquam morbi ut ultricies elementum adipiscing purus proin semper. Viverra accumsan tempus, vitae auctor a. Dictumst cras dui sit feugiat. Enim nulla pulvinar urna sit eu placerat.

Nascetur nisi, tortor velit et ipsum commodo. Tempor massa, non suscipit at sagittis morbi eget euismod.

Lacus, ultrices in ultrices tellus odio nunc urna. Massa aenean sed ipsum praesent enim. Porttitor iaculis augue pulvinar nam feugiat. Aliquam morbi ut ultricies elementum adipiscing purus proin semper. Viverra accumsan tempus, vitae auctor a. Dictumst cras dui sit feugiat. Enim nulla pulvinar urna sit eu placerat.

Nascetur nisi, tortor velit et ipsum commodo. Tempor massa, non suscipit at sagittis morbi eget euismod.

Since their introduction >2 decades ago, percutaneous catheter-based epicardial mapping and ablation have become widely adopted by cardiac electrophysiologists around the world. Although epicardial mapping has been used for catheter ablation of a wide variety of cardiac arrhythmias, its most common use is for ablation of intramural and subepicardial substrates that give rise to ventricular tachycardia, particularly in patients with nonischemic cardiomyopathy. As such, the subxiphoid percutaneous epicardial approach has emerged as an important adjunct, and, in some cases, is the preferred strategy in this regard. This review discusses the rationale and indications for epicardial catheter mapping and/or ablation. This paper also reviews the prevalence of epicardial arrhythmias and their electrocardiographic criteria. In addition, it examines the anatomy of the pericardium and commonly used epicardial access techniques, as well as the optimal methodologies for epicardial mapping and ablation and the impact of epicardial fat. Finally, this review discusses the potential of the various complications associated with the percutaneous epicardial approach, in addition to patient-specific risk factors, and potential strategies to mitigate the risk of complications.

Lacus, ultrices in ultrices tellus odio nunc urna. Massa aenean sed ipsum praesent enim. Porttitor iaculis augue pulvinar nam feugiat. Aliquam morbi ut ultricies elementum adipiscing purus proin semper. Viverra accumsan tempus, vitae auctor a. Dictumst cras dui sit feugiat. Enim nulla pulvinar urna sit eu placerat.

Nascetur nisi, tortor velit et ipsum commodo. Tempor massa, non suscipit at sagittis morbi eget euismod.

Lacus, ultrices in ultrices tellus odio nunc urna. Massa aenean sed ipsum praesent enim. Porttitor iaculis augue pulvinar nam feugiat. Aliquam morbi ut ultricies elementum adipiscing purus proin semper. Viverra accumsan tempus, vitae auctor a. Dictumst cras dui sit feugiat. Enim nulla pulvinar urna sit eu placerat.

Nascetur nisi, tortor velit et ipsum commodo. Tempor massa, non suscipit at sagittis morbi eget euismod.

Lacus, ultrices in ultrices tellus odio nunc urna. Massa aenean sed ipsum praesent enim. Porttitor iaculis augue pulvinar nam feugiat. Aliquam morbi ut ultricies elementum adipiscing purus proin semper. Viverra accumsan tempus, vitae auctor a. Dictumst cras dui sit feugiat. Enim nulla pulvinar urna sit eu placerat.

Nascetur nisi, tortor velit et ipsum commodo. Tempor massa, non suscipit at sagittis morbi eget euismod.

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

Sudden cardiac death (SCD) is a major cause of mortality in elderly individuals owing to a high prevalence of coronary heart disease, systolic dysfunction, and congestive heart failure (CHF). Although the incidence of SCD increases with age, the proportion of cardiac deaths that are sudden decreases owing to high numbers of other cardiac causes of death in elderly individuals. Implantable cardioverter-defibrillator (ICD) therapy has been demonstrated to improve survival and prevent SCD in selected patients with systolic dysfunction and CHF. However, ICD therapy in elderly patients might not be effective because of a greater rate of pulseless electrical activity underlying SCD and other competing nonarrhythmic causes of death in this population. Although under-represented in randomized trials of ICD use, elderly patients comprise a substantial proportion of the population that qualifies for and receives an ICD for primary prevention under current guidelines. Cardiac resynchronization therapy (CRT), which has been demonstrated to reduce mortality in selected populations with heart failure, is also more commonly used in this group of patients than in younger individuals. In this Review, we examine the causes of SCD in elderly individuals, and discuss the existing evidence for effectiveness of ICD therapy and CRT in this growing population.