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Safety and prevention of complications during percutaneous epicardial access for the ablation of cardiac arrhythmias

  • Han S. Lim
    Affiliations
    Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, France; and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France
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  • Frédéric Sacher
    Correspondence
    Address reprint requests and correspondence: Dr Frédéric Sacher, Hôpital Cardiologique du Haut-Lévêque, 33604 Bordeaux-Pessac, France
    Affiliations
    Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, France; and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France
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  • Hubert Cochet
    Affiliations
    Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, France; and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France
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  • Benjamin Berte
    Affiliations
    Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, France; and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France
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  • Seigo Yamashita
    Affiliations
    Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, France; and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France
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  • Saagar Mahida
    Affiliations
    Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, France; and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France
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  • Stephan Zellerhoff
    Affiliations
    Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, France; and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France
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  • Yuki Komatsu
    Affiliations
    Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, France; and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France
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  • Arnaud Denis
    Affiliations
    Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, France; and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France
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  • Nicolas Derval
    Affiliations
    Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, France; and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France
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  • Mélèze Hocini
    Affiliations
    Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, France; and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France
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  • Michel Haïssaguerre
    Affiliations
    Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, France; and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France
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  • Pierre Jaïs
    Affiliations
    Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, France; and INSERM U1045 - L’Institut de Rythmologie et Modeling Cardiaque, Bordeaux, France
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      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.
      • Sosa E.
      • Scanavacca M.
      • d’Avila A.
      • Pilleggi F.
      A new technique to perform epicardial mapping in the electrophysiology laboratory.
      A thorough understanding of the clinical anatomy and potential complications is vital in order to perform a safe procedure.
      • Sacher F.
      • Roberts-Thomson K.
      • Maury P.
      • et al.
      Epicardial ventricular tachycardia ablation a multicenter safety study.
      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

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