Hands On
Safety and prevention of complications during percutaneous epicardial access for the ablation of cardiac arrhythmias
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.LAA ligation using the LARIAT suture delivery device: Tips and tricks for a successful procedure
Chronic oral anticoagulation (OAC) has traditionally been considered as the most effective prophylaxis against thromboembolic events in patients with atrial fibrillation (AF). However, as many as 20% of the patients with AF are not candidates for OAC.1,2 Reasons for ineligibility range from intracranial bleeding (the most serious complication) to increased propensity for mechanical injury (the least serious complication). The resumption of OAC in patients who have suffered a life-threatening complication due to OAC is associated with a much higher risk of such events in the future.Safety and feasibility of transseptal puncture for atrial fibrillation ablation in patients with atrial septal defect closure devices
AF is often found in association with an ASD.1–4 There are an increasing number of patients undergoing transcatheter closure of an ASD who subsequently develop AF in clinical practice.2–4 Catheter ablation has emerged as an effective treatment strategy for drug-refractory symptomatic AF.5 While transseptal access to the left atrium (LA) is a prerequisite for AF ablation, it may prove difficult in the presence of an ASD closure device.6,7 Anticipating technical difficulties and potential complications may discourage operators from considering catheter ablation of AF in this particular patient population.
