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Address reprint requests and correspondence: Dr. Andre d'Avila, Helmsely Cardiac Arrhythmia Service, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029
Percutaneous epicardial access (Figs. 1A and 1B) has gained wide acceptance as an interventional technique to access the pericardial
space. Since its initial description
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 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).
Subxiphoid surgical approach for epicardial catheter-based mapping and ablation in patients with prior cardiac surgery or difficult pericardial access.
Experimental efficacy of pericardial instillation of anti-inflammatory agents during percutaneous epicardial catheter ablation to prevent postprocedure pericarditis.
