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Epicardial Ablation Available for the Most Complex Arrhythmias 

Written by Matthew Kapalis, DO, FHRS

Bryan Heart has continued its focus on delivering a comprehensive approach to complex heart disease. Cardiac catheter ablation is a cornerstone for safe, long-term treatment for many cardiac arrhythmias. Ablation uses radiofrequency energy or cryotherapy to neutralize electrical activity. Bryan Medical Center has maintained a state-of-the-art array of catheters, mapping systems and a robotic system to tailor care at the appropriate level to each patient. In the last year we have added another ablation procedure – epicardial ablation – which modifies muscles and nerves on the heart’s surface.

Epicardial ablation was born from a need for efficiency; ablation from the standard endocardial approach fails in 25% of cases. We know that arrhythmia circuits have a three-dimensional structure that cannot be fully treated by one approach. Advances in mapping technology and catheters have allowed for a safer and more effective epicardial procedure.  

Our general approach for epicardial ablations is selecting patients with ventricular tachycardia who have not had effective results from a previous endocardial ablation procedure.  Additionally, there are ECG clues that suggest an epicardial source of the ventricular arrhythmia. Due to the challenges in reaching the epicardial space this is not a modality commonly used.     

Procedure Overview:

  1. To reach the epicardial space, the patient is first sedated with general anesthesia. 
  2. Under sterile technique a special needle is directed under the sternum and passes through the pericardial sack. 
  3. A wire is inserted through the needle to allow for a directable sheath to be inserted into this space. 
  4. The ablation catheter is inserted to map the electrical signals of heart’s surface. Just like with endocardial ablation, we are able to collect this data to create a computer-generated model of the electrical anatomic substrate of the heart’s surface. This commonly is paired with an electrical anatomic map of the endocardial surface of the ventricle. 
  5. When the area of interest is identified, we check for the proximity of the phrenic nerves and coronary arteries. 
  6. Ablation lesion set is then tailored to the patient to target the arrhythmia without collateral damage to healthy structure in and around the heart.
  7. Finally, the catheter and sheaths are removed. With this approach there is minimal post-procedure recovery required. 

Treating Complex Arrhythmias

This level of expertise enhances the sophistication of Bryan Medical Center’s electrophysiology labs. This suite of technology enables us to treat the most complex arrhythmias, as we can use an epicardial ablation approach in patients who have had previously unsuccessful ablations. Bryan Heart and Bryan Medical Center are one of the region’s most experienced arrhythmia teams, performing more than 700 ablations in the past year. 

For questions, or to refer a patient, call 402-483-3333. 

Matthew Kapalis, DO, FHRS

About Matthew Kapalis, DO, FHRS

Matthew Kapalis, DO, FHRS, is a cardiologist at Bryan Heart. Kapalis is a graduate of Des Moines University Osteopathic Medical Center. He completed his residency at the University of Minnesota Medical School and fellowship at The University of Nebraska Medical Center. He is certified with the American Board of Internal Medicine and is a fellow of the Heart Rhythm Society (FHRS).

View Dr. Kapalis' physician profile

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