Anatomical consideration for safe pericardiocentesis assessed by three‐dimensional computed tomography: Should an anterior or posterior approach be used?

Abstract

a b s t r a c tBackground: The efficacy of epicardial catheter ablation for ventricular tachycardia has been reported. However, the safest anatomical method for pericardial puncture has not been determined. Methods: Thirty patients who underwent 3-dimensional computed tomography (3D-CT) preceding catheter ablations for atrial fibrillation were enrolled in this study. We used the skin surface 1 cm below the xiphisternum as the puncture site. For the anterior approach, the attainment site was the pericardium of the mid portion of right ventricular anterior site, and for the posterior approach it was the pericardium of the inferior ventricular site. The distance and the angle between the 2 sites were measured using 3D-CT. Results: For the anterior approach, the distance was 54711 mm and the needle angle was 377111 toward the left scapula and 347121 towards the back of the body. For the posterior approach, the distance was 56710 mm and the corresponding needle angles were 60791 and 867131. The distance correlated with BMI for the anterior and posterior approaches (anterior approach: r 2 ¼0.43, Po0.001; posterior approach: r 2 ¼0.49, Po0.001). Liver existed along the pathway of the posterior approach in 11 (37%) of 30 patients, and through in 2 (18%) of 11 patients. The liver and lung were not located along the pathway of the anterior approach in any patients. Conclusions: Performing subxiphoid pericardiocentesis is anatomically safer via the anterior approach than via the posterior approach.

Computed tomography-guided pericardiocentesis: a systematic review concerning contemporary evidence and future perspectives

“…After full-text analysis, six studies were excluded from this review. Of these, three studies used CT to characterize PE in patients who were subjected to echocardiography-guided 22,23 or fluoroscopy-guided pericardiocentesis, 24 one used CT to assess the site of pericardial puncture in an ablation procedure, 25 one used the technique to quantify PE in patients prior to percutaneous pericardiocentesis (not specifying that CT was the method of choice for guiding the procedure) 26 and another concerned mainly the non-invasive evaluation of PE (not presenting data concerning the pericardiocentesis procedure). 18 No further articles were excluded, and all described the number of individuals assessed, as well as the success rate.…”