Epicardial access complications during electrophysiology procedures

Abstract

Introduction Percutaneous epicardial access (EA) was first described more than two decades ago. Since its initial introduction, indications for its utilization in the field of electrophysiology have expanded dramatically. Discussion Epicardial mapping and ablation in patients with ventricular tachycardia is routinely performed in tertiary electrophysiology centers around the world. Although limited by lack of randomized controlled trials, epicardial ablation for atrial fibrillation has been suggested as a conjunctive strategy in patients who have failed an initial endocardial catheter ablation attempt, and it is necessary for placement of some left atrial appendage occlusion devices as well. An accurate understanding of the cardiac anatomy is crucial to avoid complications such as inadvertent right ventricular puncture, injury to the coronary arteries, abdominal viscera, phrenic nerves, and esophagus during both EA and catheter ablation. Conclusion The aim of this review is to provide a comprehensive overview of the cardiac anatomy, technical aspects to optimize the safety of epicardial puncture, recognize and avoid potential complications.

Percutaneous epicardial pacing in infants using direct visualization: A feasibility animal study

“…However, the pericardial access technique for these ablations remains risky with a significant chance for major complications. These include inadvertent ventricular perforation, pleural injury, phrenic nerve injury or coronary injury that can lead to pericardial effusions, tamponade, or even death 44–46 . The ability to achieve pericardial access under direct visualization could mitigate many of these potential complications.…”

Subcutaneous ICD Implantation and Catheter Ablation

“… 4 Therefore, CA represents a promising solution to the lack of ATP in patients ARVC who would otherwise be eligible for an S-ICD. Conversely, CA is associated with possible major complications, especially when the epicardial approach is used; 11 thus, it should be reserved for tertiary centers. Notably, our patient underwent S-ICD insertion with the aim of eventually treating recurrent VTs with ablation.…”

Successful ventricular tachycardia radioablation in a patient with previous chemical pleurodesis: A case report

“…In such cases, standard endocardial ablation can be complemented by the use of epicardial mapping and ablation through surrounding anatomical structures (e.g., coronary veins, coronary cusps) or through percutaneous subxyphoid pericardial puncture, which allows direct access to the epicardium ( 10 ). This procedure carries a series of risks and complications, which include RV puncture and pericardial bleeding, damage to coronary arteries and injury to surrounding structures ( 11 ). In addition, patients may present preexisting conditions that make the direct epicardial access unfeasible.…”