Management of hemopericardium related to percutaneous epicardial access, mapping, and ablation

      Percutaneous epicardial access (Figs. 1A and 1B) has gained wide acceptance as an interventional technique to access the pericardial space. Since its initial description
      • Sosa E.
      • Scanavacca M.
      • D'Avila A.
      • Pilleggi E.
      A new technique to perform epicardial mapping in the electrophysiology laboratory.
      in targeting epicardial circuits of ventricular tachycardia (VT) in patients with Chagasic cardiomyopathy, percutaneous epicardial access and ablation has come to play an important role in interventional electrophysiology. This technique has been recognized as a vital addition to catheter ablation of certain cardiac arrhythmias and for the delivery of newer investigational devices such as epicardial suture ligation of the left atrial appendage. Thus, the utilization of the percutaneous epicardial approach is set to likely increase.
      Figure thumbnail gr1
      Figure 1A: Guidewire in the right ventricular outflow tract. B: Typical position of guidewire in the pericardial space. C, D: Echocardiographic views (short-axis and 4-chamber views) of hemopericardium (double arrows).



      RV (right ventricle), VT (ventricular tachycardia)
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