Since its introduction, percutaneous epicardial access is increasingly being performed
to facilitate catheter ablation of ventricular tachycardias (VTs) with epicardial
circuits, difficult cases of idiopathic VTs, focal atrial tachycardia, and accessory
pathways that cannot be successfully targeted endocardially.
1
A thorough understanding of the clinical anatomy and potential complications is vital
in order to perform a safe procedure.
2
In this article, we present the clinical anatomy related to epicardial access, the
technique of performing a subxiphoid epicardial puncture, and various measures to
prevent complications.Abbreviations:
LA (left atrium/atrial), LAO (left anterior oblique), LV (left ventricle/ventricular), RV (right ventricle/ventricular), VT (ventricular tachycardia)Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart RhythmAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A new technique to perform epicardial mapping in the electrophysiology laboratory.J Cardiovasc Electrophysiol. 1996; 7: 531-536
- Epicardial ventricular tachycardia ablation a multicenter safety study.J Am Coll Cardiol. 2010; 55: 2366-2372
- Pericardiocentesis: a clinical anatomy review.Clin Anat. 2012; 25: 872-881
- Congenital partial and complete absence of the pericardium.Mayo Clin Proc. 1993; 68: 743-747
- Correlative anatomy for the electrophysiologist, Part I: The pericardial space, oblique sinus, transverse sinus.J Cardiovasc Electrophysiol. 2010; 21: 1421-1426
- Characterization of the phrenic nerve course within the epicardial substrate of patients with nonischemic cardiomyopathy and ventricular tachycardia.Heart Rhythm. 2009; 6: 59-64
- How close are the phrenic nerves to cardiac structures? Implications for cardiac interventionalists.J Cardiovasc Electrophysiol. 2005; 16: 309-313
- Utility of the lateral fluoroscopic view for subxiphoid pericardial access.Circ Arrhythm Electrophysiol. 2009; 2: e15-e17
- Epicardial mapping and ablation techniques to control ventricular tachycardia.J Cardiovasc Electrophysiol. 2005; 16: 449-452
- Strategies for epicardial mapping and ablation of ventricular tachycardia.J Cardiovasc Electrophysiol. 2009; 20: 710-713
- Transthoracic epicardial catheter ablation.Circ J. 2013; 77: 1672-1680
- Transthoracic epicardial catheter ablation to treat recurrent ventricular tachycardia.Curr Cardiol Rep. 2001; 3: 451-458
- Acute and chronic effects of epicardial radiofrequency applications delivered on epicardial coronary arteries.Circ Arrhythm Electrophysiol. 2011; 4: 526-531
- Unusual complications of percutaneous epicardial access and epicardial mapping and ablation of cardiac arrhythmias.Circ Arrhythm Electrophysiol. 2011; 4: 882-888
- Multimodality imaging to improve the safety and efficacy of epicardial ablation of scar-related ventricular tachycardia.J Cardiovasc Electrophysiol. 2013; 24: 1426-1427
- Images in cardiovascular medicine: novel technique to prevent left phrenic nerve injury during epicardial catheter ablation.Circulation. 2008; 117: e471
- Aspirated air in the pericardial space during epicardial catheterization may elevate the defibrillation threshold.Int J Cardiol. 2009; 135: e34-e35
- Experimental efficacy of pericardial instillation of anti-inflammatory agents during percutaneous epicardial catheter ablation to prevent postprocedure pericarditis.J Cardiovasc Electrophysiol. 2007; 18: 1178-1183
- Epicardial access for the treatment of cardiac arrhythmias.Europace. 2012; 14: ii13-ii18
- Subxiphoid surgical approach for epicardial catheter-based mapping and ablation in patients with prior cardiac surgery or difficult pericardial access.Circulation. 2004; 110: 1197-1201
Article info
Publication history
Published online: June 05, 2014
Footnotes
Dr Lim was supported by the Neil Hamilton Fairley Early Career Fellowship from the National Health and Medical Research Council of Australia.
Identification
Copyright
© 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
