Application of combined ablation procedures via percutaneous epi/endocardial access in patients with recurrent atrial fibrillation

Objective We aimed to evaluate the feasibility, safety and efficacy of combined ablation procedures via percutaneous epi/endocardial access in patients with recurrent atrial fibrillation (AF). Methods Twelve symptomatic patients with recurrent AF who received ablation at least twice before were enrolled in this study from September 2016 to January 2017.We did both epi/endocardial mapping and ablation via percutaneous subxiphoid pericardial and transseptal access guided by Carto 3 system (Biosence Webster, USA). The feasibility and perioperative complications were observed, and follow-up study was obtained. Results Totally 11 patients received both epicardial and endocardial mapping, and 10 of them underwent epicardial ablation.Endocardial mapping indicated that 7 patients still kept isolation of the 4 pulmonary veins (PVs), and further endo procedures terminated 4 atrial tachycardia(ATs) and blocked 6 ablation lines.Epicardial procedures terminated 3 ATs including one premature atrial contraction (PAC) and blocked 4 refractory ablation lines.No tamponade or other perioperative complications were observed during a mean follow-up of 3.8±1.4 months. Conclusion For refractory AF patients with repeated ablation, it might be safe and feasible to undergo mapping and ablation via both percutaneous epi/endocardial access. Key words: Atrial fibrillation; Percutaneous pericardial puncture; Radiofrequency ablation