Percutaneous Access of the Epicardial Space for Mapping Ventricular and Supraventricular Arrhythmias in Patients With and Without Prior Cardiac Surgery
- 26 March 2010
- journal article
- Published by Wiley in Journal of Cardiovascular Electrophysiology
- Vol. 21 (4), 406-411
- https://doi.org/10.1111/j.1540-8167.2009.01645.x
Abstract
Percutaneous Epicardial Access. Introduction: There is a paucity of data on the success rates of achieving percutaneous epicardial access in different groups of patients. Methods and Results: Percutaneous epicardial access was attempted in 137 patients having 149 procedures; 19 patients had supraventricular tachycardia (SVT), 25 patients had idiopathic VT and 93 patients had scar‐related ventricular tachycardia (VT). Ten patients had prior cardiac surgery. Successful epicardial access was achieved in 133 of 149 (89.3%) procedures. Access was achieved in 17 of 19 (89.5%) patients with SVT, all patients with idiopathic VT, 80 of 93 (86.0%) patients with scar‐related VT and in 2 (20%) patients with prior cardiac surgery. Attempted access failed in 16 patients; 8 had prior cardiac surgery and 3 had prior pericarditis. After an initial procedure, repeat access was attempted in 15 patients, 5.1 ± 5.4 months after initial epicardial mapping and ablation. Access was successful in 13 (86.7%) and failed in 2 patients who had pericarditis after their first procedure. Only 4 patients were given intrapericardial glucocorticoid at their first epicardial procedure. Prior cardiac surgery and a history of pericarditis predicted unsuccessful access (P < 0.01). Complications (9 patients) included pericardial bleeding (80–250 mL) and intraabdominal bleeding. Conclusions: In patients without prior cardiac surgery, percutaneous epicardial access can be obtained in the majority of patients. Prior cardiac surgery precludes access in the most patients and when possible adhesions may limit catheter movement. Repeat access is possible in the majority of patients without the installation of intrapericardial glucocorticoid at the first procedure. (J Cardiovasc Electrophysiol, Vol. 21, pp. 406–411, April 2010)Keywords
This publication has 19 references indexed in Scilit:
- Atrial tachycardias adjacent to the phrenic nerve: Recognition, potential problems, and solutionsHeart Rhythm, 2009
- Experimental Efficacy of Pericardial Instillation of Anti‐inflammatory Agents during Percutaneous Epicardial Catheter Ablation to Prevent Postprocedure PericarditisJournal of Cardiovascular Electrophysiology, 2007
- Subxiphoid Surgical Approach for Epicardial Catheter-Based Mapping and Ablation in Patients With Prior Cardiac Surgery or Difficult Pericardial AccessCirculation, 2004
- Endocardial and epicardial radiofrequency ablation of ventricular tachycardia associated with dilated cardiomyopathyJournal of the American College of Cardiology, 2004
- Characterization of Endocardial Electrophysiological Substrate in Patients With Nonischemic Cardiomyopathy and Monomorphic Ventricular TachycardiaCirculation, 2003
- Radiofrequency Catheter Ablation of Ventricular Tachycardia Guided by Nonsurgical Epicardial Mapping in Chronic Chagasic Heart DiseasePacing and Clinical Electrophysiology, 1999
- Endocardial and Epicardial Ablation Guided by Nonsurgical Transthoracic Epicardial Mapping to Treat Recurrent Ventricular TachycardiaJournal of Cardiovascular Electrophysiology, 1998
- A New Technique to Perform Epicardial Mapping in the Electrophysiology LaboratoryJournal of Cardiovascular Electrophysiology, 1996
- Functional role of the epicardium in postinfarction ventricular tachycardia. Observations derived from computerized epicardial activation mapping, entrainment, and epicardial laser photoablation.Circulation, 1991
- Termination of ventricular tachycardia with epicardial laser photocoagulation: A clinical comparison with patients undergoing successful endocardial photocoagulation aloneJournal of the American College of Cardiology, 1990