Ablation and Surgery for PVCs.

I’m paraphrasing this from an expert in the field and this procedure who I’m close with. They gave me this answer.
Epicardial ablation refers to ablation on the outside of the heart. In that procedure, a catheter is placed under the rib cage and into the pericardium, the sack around the heart. It is typically not done as an open surgery. It was developed in Brazil in the mid 1990s because many rural citizens of Brazil suffered from a condition called Chagas disease, where they were exposed to insects that would cause bites and causing inflammation on the outside of the heart.

This technique was then brought to the United States by electrophysiologists such as Andrea Natale (Houston) and Paul Friedman (Mayo Rochester) and others, who published a series of papers demonstrating that if the heart muscle is too thick so that the more traditional endocardial ablation, from within the heart, could not treat an arrhythmia because the hotspot causing the rhythm disorder was deeper in the muscle, ablation from the outside could treat it.

Epicardial ablation does have additional risks. If the hotspot is near a coronary artery, which sits on the outside of the heart, it could be injured with a pericardial ablation. Sometimes a drain is left in place, which can be uncomfortable or painful, and some doctors leave it in for a couple of days and others will remove it at the end of the procedure. It has both been done under general anesthesia and under deep sedation, and it’s important to ask what approach will be taken.

There are newer techniques also being developed called pulse field ablation that allow for deeper energy and may be an alternative, although it is less well established. Sometimes alcohol can be put in veins to treat hot spots that are deep, and this can also be an alternative. The key is to find an electrophysiologist who is very experienced, and a center that has done at least 40 to 50 a year of these procedures and has accumulatively done hundreds. These are important questions to ask about.

I’m paraphrasing this from an expert in the field and this procedure who I’m close with. They gave me this answer.
Epicardial ablation refers to ablation on the outside of the heart. In that procedure, a catheter is placed under the rib cage and into the pericardium, the sack around the heart. It is typically not done as an open surgery. It was developed in Brazil in the mid 1990s because many rural citizens of Brazil suffered from a condition called Chagas disease, where they were exposed to insects that would cause bites and causing inflammation on the outside of the heart.

This technique was then brought to the United States by electrophysiologists such as Andrea Natale (Houston) and Paul Friedman (Mayo Rochester) and others, who published a series of papers demonstrating that if the heart muscle is too thick so that the more traditional endocardial ablation, from within the heart, could not treat an arrhythmia because the hotspot causing the rhythm disorder was deeper in the muscle, ablation from the outside could treat it.

Epicardial ablation does have additional risks. If the hotspot is near a coronary artery, which sits on the outside of the heart, it could be injured with a pericardial ablation. Sometimes a drain is left in place, which can be uncomfortable or painful, and some doctors leave it in for a couple of days and others will remove it at the end of the procedure. It has both been done under general anesthesia and under deep sedation, and it’s important to ask what approach will be taken.

There are newer techniques also being developed called pulse field ablation that allow for deeper energy and may be an alternative, although it is less well established. Sometimes alcohol can be put in veins to treat hot spots that are deep, and this can also be an alternative. The key is to find an electrophysiologist who is very experienced, and a center that has done at least 40 to 50 a year of these procedures and has accumulatively done hundreds. These are important questions to ask about.