{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T20:39:36Z","timestamp":1791319176192,"version":"4.3.1"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T00:00:00Z","timestamp":1682467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Scar-related ventricular tachycardia (VT) is a challenging medical condition, with catheter ablation providing a valuable treatment option. Whilst most VTs can be ablated endocardially, epicardial ablation is often required in patients with non-ischaemic cardiomyopathy. The percutaneous subxiphoid technique has become instrumental for epicardial access. However, it is not feasible in up to 28% of cases for multiple reasons.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 47-year-old patient was managed at our centre for VT storm and recurrent implantable cardioverter defibrillator shocks for monomorphic VT despite maximum drug therapy. No scar was noted during endocardial mapping, with confirmation of the localized epicardial scar on cardiac magnetic resonance imaging (CMR). Following failed percutaneous epicardial access, a successful hybrid surgical epicardial VT cryoablation via median sternotomy was performed in the electrophysiology (EP) laboratory utilizing data from CMR, prior endocardial ablation, and conventional EP mapping. The patient has remained arrhythmia-free for 30 months post-ablation without antiarrhythmic therapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>This case describes a practical multidisciplinary approach to managing a challenging clinical problem. Whilst the described technique is not entirely novel, this is the first case report that describes the practicalities and demonstrates the safety and feasibility of hybrid epicardial cryoablation via median sternotomy performed in the cardiac EP laboratory for the sole treatment of VT.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytad223","type":"journal-article","created":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T23:24:45Z","timestamp":1682551485000},"source":"Crossref","is-referenced-by-count":2,"title":["Hybrid surgical epicardial cryoablation for ventricular tachycardia in the electrophysiology laboratory: a case report"],"prefix":"10.1093","volume":"7","author":[{"given":"Nikesh","family":"Jathanna","sequence":"first","affiliation":[{"name":"Trent Cardiac Centre, Nottingham City Hospital, Nottingham University Hospitals NHS Trust , Hucknall Road, Nottingham, NG5 1PB , UK"},{"name":"School of Medicine, University of Nottingham, University Park, Queens Medical Centre , East Block, Lenton, Nottingham, NG7 2UH , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selvaraj","family":"Shanmuganathan","sequence":"additional","affiliation":[{"name":"Trent Cardiac Centre, Nottingham City Hospital, Nottingham University Hospitals NHS Trust , Hucknall Road, Nottingham, NG5 1PB , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Staniforth","sequence":"additional","affiliation":[{"name":"Trent Cardiac Centre, Nottingham City Hospital, Nottingham University Hospitals NHS Trust , Hucknall Road, Nottingham, NG5 1PB , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahnaz","family":"Jamil-Copley","sequence":"additional","affiliation":[{"name":"Trent Cardiac Centre, Nottingham City Hospital, Nottingham University Hospitals NHS Trust , Hucknall Road, Nottingham, NG5 1PB , UK"},{"name":"School of Medicine, University of Nottingham, University Park, Queens Medical Centre , East Block, Lenton, Nottingham, NG7 2UH , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,4,26]]},"reference":[{"key":"2023051010030241900_ytad223-B1","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.cjco.2019.04.003","article-title":"The effect of shock burden on heart failure and mortality","volume":"1","author":"MacIntyre","year":"2019","journal-title":"CJC Open"},{"key":"2023051010030241900_ytad223-B2","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCOUTCOMES.115.002210","article-title":"Healthcare utilization and expenditures associated with appropriate and inappropriate implantable defibrillator shocks","volume":"10","author":"Turakhia","year":"2017","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"2023051010030241900_ytad223-B3","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1161\/01.CIR.0000134957.51747.6E","article-title":"Long-term comparison of the implantable cardioverter defibrillator versus amiodarone: eleven-year follow-up of a subset of patients in the Canadian Implantable Defibrillator Study (CIDS)","volume":"110","author":"Bokhari","year":"2004","journal-title":"Circulation"},{"key":"2023051010030241900_ytad223-B4","doi-asserted-by":"crossref","first-page":"34","DOI":"10.3389\/fcvm.2015.00034","article-title":"Quality of life in patients with an implantable cardioverter defibrillator: a systematic review","volume":"2","author":"Tomzik","year":"2015","journal-title":"Front Cardiovasc Med"},{"key":"2023051010030241900_ytad223-B5","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1093\/europace\/eut304","article-title":"Role of electrical storm as a mortality and morbidity risk factor and its clinical predictors: a meta-analysis","volume":"16","author":"Guerra","year":"2014","journal-title":"Europace"},{"key":"2023051010030241900_ytad223-B6","doi-asserted-by":"crossref","first-page":"3997","DOI":"10.1093\/eurheartj\/ehac262","article-title":"2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: developed by the task force for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC) Endorsed by the Association for European Paediatric and Congenital Cardiology (AEPC)","volume":"43","author":"Zeppenfeld","year":"2022","journal-title":"Eur Heart J"},{"key":"2023051010030241900_ytad223-B7","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1111\/j.1540-8167.1996.tb00559.x","article-title":"A new technique to perform epicardial mapping in the electrophysiology laboratory","volume":"7","author":"Sosa","year":"1996","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2023051010030241900_ytad223-B8","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1161\/01.CIR.0000140725.42845.90","article-title":"Subxiphoid surgical approach for epicardial catheter-based mapping and ablation in patients with prior cardiac surgery or difficult pericardial access","volume":"110","author":"Soejima","year":"2004","journal-title":"Circulation"},{"key":"2023051010030241900_ytad223-B9","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1161\/CIRCEP.114.002522","article-title":"Role of alternative interventional procedures when endo- and epicardial catheter ablation attempts for ventricular arrhythmias fail","volume":"8","author":"Kumar","year":"2015","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2023051010030241900_ytad223-B10","doi-asserted-by":"crossref","first-page":"203","DOI":"10.4070\/kcj.2019.0292","article-title":"Ventricular tachycardia ablation in non-ischemic cardiomyopathy","volume":"50","author":"Bhaskaran","year":"2020","journal-title":"Korean Circ J"},{"key":"2023051010030241900_ytad223-B11","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1016\/j.hrthm.2017.06.003","article-title":"Association of preprocedural cardiac magnetic resonance imaging with outcomes of ventricular tachycardia ablation in patients with idiopathic dilated cardiomyopathy","volume":"14","author":"Siontis","year":"2017","journal-title":"Heart Rhythm"},{"key":"2023051010030241900_ytad223-B12","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1016\/j.hrthm.2010.07.009","article-title":"Hybrid procedures for epicardial catheter ablation of ventricular tachycardia: value of surgical access","volume":"7","author":"Michowitz","year":"2010","journal-title":"Heart Rhythm"},{"key":"2023051010030241900_ytad223-B13","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1016\/j.hrthm.2017.11.009","article-title":"Hybrid surgical vs percutaneous access epicardial ventricular tachycardia ablation","volume":"15","author":"Li","year":"2018","journal-title":"Heart Rhythm"},{"key":"2023051010030241900_ytad223-B14","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1161\/CIRCEP.111.962555","article-title":"Surgical ablation of refractory ventricular tachycardia in patients with nonischemic cardiomyopathy","volume":"4","author":"Anter","year":"2011","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2023051010030241900_ytad223-B15","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1111\/jce.12839","article-title":"Safety and feasibility of open chest epicardial mapping and ablation of ventricular tachycardia during the period of left ventricular assist device implantation","volume":"27","author":"Patel","year":"2016","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2023051010030241900_ytad223-B16","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1111\/j.1540-8167.2012.02334.x","article-title":"Comparison of epicardial cryoablation and irrigated radiofrequency ablation in a swine infarct model","volume":"23","author":"Jauregui-Abularach","year":"2012","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2023051010030241900_ytad223-B17","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1111\/j.1540-8159.2008.01184.x","article-title":"Focal and linear endocardial and epicardial catheter-based cryoablation of normal and infarcted ventricular tissue","volume":"31","author":"D\u2019Avila","year":"2008","journal-title":"Pacing Clin Electrophysiol"},{"key":"2023051010030241900_ytad223-B18","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1097\/MAT.0b013e3182a394f1","article-title":"Ablation technology for the surgical treatment of atrial fibrillation","volume":"59","author":"Melby","year":"2013","journal-title":"ASAIO J"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytad223\/50104477\/ytad223.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/7\/5\/ytad223\/50262689\/ytad223.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/7\/5\/ytad223\/50262689\/ytad223.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T04:06:40Z","timestamp":1683778000000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytad223\/7143666"}},"subtitle":[],"editor":[{"given":"David","family":"Duncker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Linh","family":"Ngo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Carlos Minguito","family":"Carazo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Nikolaos","family":"Spinthakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Jonathan","family":"Senior","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,4,26]]},"references-count":18,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2023,5,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytad223","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,5]]},"published":{"date-parts":[[2023,4,26]]},"article-number":"ytad223"}}