Percutaneous Pericardiocentesis With the Anterior Approach

• Published in: JACC. Clinical electrophysiology 2019-06, Vol.5 (6), p.730-741
• Main Authors: Fukuzawa, Koji, Nagamatsu, Yuichi, Mori, Shumpei, Kiuchi, Kunihiko, Takami, Mitsuru, Izawa, Yu, Konishi, Hiroki, Ichibori, Hirotoshi, Imada, Hiroshi, Hyogo, Kiyohiro, Kurose, Jun, Suehiro, Hideya, Akita, Tomomi, Takemoto, Makoto, Shimoyama, Shinsuke, Yoshida, Akihiro, Hirata, Ken-ichi
• Format: Article
• Language: English
• Subjects: anterior approach; computed tomography; epicardial ablation; pericardiocentesis; ventricular tachycardia
• ISSN: 2405-500X; 2405-5018
• DOI: 10.1016/j.jacep.2019.03.017

This study aimed to confirm the precise course of a pericardiocentesis with the anterior approach using post-procedural computed tomography (CT). Percutaneous epicardial ventricular tachycardia (VT) ablation has been increasingly performed. Although the inferior approach has been the common method, the feasibility of the anterior approach has subsequently been reported. However, the precise course of the anterior approach has not been presented. An epicardial ablation with the anterior approach was performed in 15 patients. At the end of the procedure, the epicardial sheath was exchanged for a drainage tube to monitor bleeding. Of those patients, in 9 procedures in 8 patients a CT scan was performed just after the procedure to confirm the course of the drainage tube and to rule out any complications. Epicardial ablation was indicated for a failed endocardial VT ablation in 7 patients and epicardial substrate modification in 1 patient with Brugada syndrome. Volume-rendered images reconstructed from CT demonstrated each course of the drainage tubes and their relation to the surrounding organs. These images revealed that the tube had a curved trace, and did not penetrate the diaphragm or pass through the abdominal cavity. No injury to the surrounding organs was detected in any of the cases. The precise course of the drainage tube placed along the trajectory of the anterior approach was able to be confirmed using post-procedural CT images. These images support the safety and feasibility of the anterior approach from the anatomic standpoint with a low incidence of abdominal viscera injury. [Display omitted]