“Needle-in-needle” epicardial access: Preliminary observations with a modified technique for facilitating epicardial interventional procedures

Kumar, Saurabh; Bazaz, Raveen; Barbhaiya, Chirag R.; Enriquez, Alan D.; Helmbold, Alan F.; Chinitz, Jason S.; Baldinger, Samuel H.; Mahida, Saagar; McConville, James W.; Tedrow, Usha B.; John, Roy M.; Michaud, Gregory F.; Stevenson, William G.

doi:10.1016/j.hrthm.2015.03.045

Cited by 66 publications

(45 citation statements)

References 26 publications

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“…Targeted delivery of medications using micropuncture needles that may lead to minimal tissue disruption and vascular injury offers another avenue of exploration. Dry pericardial access using a needle-in-needle technique65 has been described, and such technique can be considered in some patients at increased risk of complications. Similar techniques could potentially be considered for SGNB by incorporating a blunt needle66 or echogenic needles67 to limit vascular injury and nerve damage.…”

Section: Discussionmentioning

confidence: 99%

Complications associated with stellate ganglion nerve block: a systematic review

Goel

Patwardhan

Ibrahim

et al. 2019

Reg Anesth Pain Med

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Stellate ganglion nerve blockade (SGNB) is a vital tool in our armamentarium for the treatment of various chronic pain syndromes. SGNB can be performed using the traditional landmark-based approach, or with image guidance using either fluoroscopy or ultrasound. In this review, we systematically analyzed reported SGNB-related complications between 1990 and 2018. Seven databases were queried for SGNB between January 1, 1990 and November 27, 2018. Search results of the complications associated with SGNB were reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Out of a total of 1909 articles, 67 articles met our inclusion criteria, yielding 260 cases with adverse events. In 134 of the 260 (51.5%) cases, SGNB was performed with image guidance. Sixty-four (24.6%) and 70 (26.9%) of the complication cases reported the use of ultrasound and fluoroscopy guidance, respectively. One hundred and seventy-eight (68.4%) patients had medication-related or systemic side effects, and 82 (31.5%) had procedure-related or local side effects. There was one report of death due to massive hematoma leading to airway obstruction. There was one case report of quadriplegia secondary to pyogenic cervical epidural abscess and discitis following an SGNB. Complications following SGNB have been reported with both landmark-based techniques and with imaging guidance using fluoroscopy or ultrasound. In our systematic review, most adverse events that were reported occurred during or shortly after SGNB. Vigilance, American Society of Anesthesiologists standard monitors for conscious sedation, and accessibility to resuscitation equipment are vital to the safe performance of SGNB.

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Section: Discussionmentioning

confidence: 99%

Complications associated with stellate ganglion nerve block: a systematic review

Goel

Patwardhan

Ibrahim

et al. 2019

Reg Anesth Pain Med

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“…Epicardial access can be achieved using a standard subxiphoid puncture under fluoroscopic guidance or in conjunction with electroanatomic mapping 62. A recent report also demonstrated the feasibility and safety of the “needle‐in‐needle” epicardial access and novel EpiAccess Needle and System with real‐time pressure monitoring, which could potentially minimize the procedural complications 63, 64…”

Section: Management Of Vt In Nicmmentioning

confidence: 99%

Ventricular arrhythmias in nonischemic cardiomyopathy

Chung

Lin

et al. 2018

Journal of Arrhythmia

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Nonischemic cardiomyopathies (NICMs) are composed of variable disease entities, including primary and secondary cardiomyopathies. Determining the etiology of NICM provides pivotal roles of not only the understanding of the individual pathogenesis, but also the clinical management, such as risk stratification, pharmacological treatment, and intervention therapies. Despite the diverse causes of NICM, these cases mostly require clinical attention owing to progressive myocardial injury, resulting in ventricular dysfunction and heart failure. The interaction between the diseased ventricular substrates and systemic/neurophysiological factors contributes to the cornerstones responsible for ventricular arrhythmogenesis and sudden cardiac death (SCD). Prevention of SCD and diminishing ventricular tachyarrhythmias are the important mainstays for the management of NICM patients. Given the understanding of the abnormal ventricular substrates and advancement of navigation systems, radiofrequency catheter ablation (RFCA) has become an adjunctive or alternative strategy for NICM patients who experience drug‐refractory ventricular tachycardias (VTs). Successful ablation can frequently be achieved at the expense of an epicardial intervention. A recent study has proven the survival benefits for NICM patients who are free from recurrent VTs after a successful RFCA, regardless of the New York Heart Association (NYHA) functional class status or left ventricular ejection fraction. Additionally, recent evidence has highlighted the better delineation of a diseased myocardium through the incorporation of cardiovascular magnetic resonance imaging (CMRI) and 3D mapping systems, which can facilitate the identification of critical ventricular arrhythmogenic substrates in NICM patients.

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“…16 Epicardial mapping was performed using the percutaneous approach if VT was suspected to be of epicardial origin. 17 Coronary angiography was performed before epicardial ablation to avoid coronary injury. The chamber (left ventricle [LV] or right ventricle [RV] and space [endo/epicardial]) mapped was based on the characteristics of the induced or spontaneous VA. 17 For the purpose of scar characterization, the ventricles were divided into basal, mid, and apical one third regions of each chamber.…”

Section: Mapping and Radiofrequency Ablationmentioning

confidence: 99%

Multicenter Experience With Catheter Ablation for Ventricular Tachycardia in Lamin A/C Cardiomyopathy

Kumar

Androulakis

Sellal

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background— Lamin A/C ( LMNA ) cardiomyopathy is a genetic disease with a proclivity for ventricular arrhythmias. We describe the multicenter experience with percutaneous catheter ablation of sustained monomorphic ventricular tachycardia (VT) in LMNA cardiomyopathy. Methods and Results— Twenty-five consecutive LMNA mutation patients from 4 centers were included (mean age, 55±9 years; ejection fraction, 34±12%; VT storm in 36%). Complete atrioventricular block was present in 11 patients; 3 patients were on mechanical circulatory support for severe heart failure. A median of 3 VTs were inducible per patient; in 82%, mapping was consistent with origin from scar in the basal left ventricle, particularly the septum, but also basal inferior wall and subaortic mitral continuity. After multiple procedures (median 2/patient; transcoronary alcohol in 6 and surgical cryoablation in 2 patients), acute success (noninducibility of any VT) was achieved in only 25% of patients. Partial success (inducibility of a nonclinical VT only: 50%) and failure (persistent inducibility of clinical VT: 12.5%) was attributed to intramural septal substrate in 13 of 18 patients (72%). Complications occurred in 25% of patients. After a median follow-up of 7 months after the last procedure, 91% experienced ≥1 VT recurrence, 44% received or were awaiting mechanical circulatory support or transplant for end-stage heart failure, and 26% died. Conclusions— Catheter ablation of VT associated with LMNA cardiomyopathy is associated with poor outcomes including high rate of arrhythmia recurrence, progression to end-stage heart failure, and high mortality. Basal septal scar and intramural VT origin makes VT ablation challenging in this population.

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“Needle-in-needle” epicardial access: Preliminary observations with a modified technique for facilitating epicardial interventional procedures

Cited by 66 publications

References 26 publications

Complications associated with stellate ganglion nerve block: a systematic review

Complications associated with stellate ganglion nerve block: a systematic review

Ventricular arrhythmias in nonischemic cardiomyopathy

Multicenter Experience With Catheter Ablation for Ventricular Tachycardia in Lamin A/C Cardiomyopathy

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