Integration of a surgical bipolar ablation device within an electroanatomical mapping system during epicardial ventricular tachycardia ablation via video-assisted thoracoscopic surgery: a case report

Epicardial ventricular tachycardia (VT) ablation is an established approach in patients with epicardial arrhythmogenic foci and is most commonly performed via percutaneous access. An alternative approach is via video-assisted thoracoscopic surgery (VATS), although reports of this technique are limited to the use of catheter-based technologies for radiofrequency ablation delivery.

A 55-year-old man with non-ischaemic cardiomyopathy presented with recurrent VT despite medical therapy. Twelve-lead ECG and cardiac MRI were suggestive of an epicardial left ventricular lateral wall breakout. Epicardial ablation was successfully performed via VATS using a linear surgical bipolar ablation device with electroanatomical mapping (EAM) integration. Following ablation, VT was non-inducible. Other than six short episodes of non-sustained during initial follow-up (up to 6 weeks), the patient remained free of ventricular arrhythmias at 18 months with minimal anti-arrhythmic therapy.

Epicardial VT ablation via VATS is feasible and allows for integration of a surgical ablation device within an EAM system. This may serve as an alternative approach in patients with a failed percutaneous ablation, or those with adverse features for a successful percutaneous procedure.