Epicardial access complications during electrophysiology procedures

Introduction Percutaneous epicardial access (EA) was first described more than two decades ago. Since its initial introduction, indications for its utilization in the field of electrophysiology have expanded dramatically. Discussion Epicardial mapping and ablation in patients with ventricular tachyc...

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Bibliographic Details
Published in:Journal of cardiovascular electrophysiology 2021-07, Vol.32 (7), p.1985-1994
Main Authors: Romero, Jorge, Patel, Kavisha, Lakkireddy, Dhanunjaya, Alviz, Isabella, Velasco, Alejandro, Rodriguez, Daniel, Karpenos, Joseph, Zhang, Xiao‐Dong, Natale, Andrea, Di Biase, Luigi
Format: Article
Language:English
Subjects:
Ablation
Anatomy
Catheters
Clinical trials
Coronary artery
Electrophysiology
epicardial ablation
epicardial access
Esophagus
Fibrillation
Heart
Nerves
Occlusion
pericardial bleeding
phrenic nerve protection and esophageal protection
right ventricular perforation
Tachycardia
Ventricle
Viscera
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Summary:Introduction Percutaneous epicardial access (EA) was first described more than two decades ago. Since its initial introduction, indications for its utilization in the field of electrophysiology have expanded dramatically. Discussion Epicardial mapping and ablation in patients with ventricular tachycardia is routinely performed in tertiary electrophysiology centers around the world. Although limited by lack of randomized controlled trials, epicardial ablation for atrial fibrillation has been suggested as a conjunctive strategy in patients who have failed an initial endocardial catheter ablation attempt, and it is necessary for placement of some left atrial appendage occlusion devices as well. An accurate understanding of the cardiac anatomy is crucial to avoid complications such as inadvertent right ventricular puncture, injury to the coronary arteries, abdominal viscera, phrenic nerves, and esophagus during both EA and catheter ablation. Conclusion The aim of this review is to provide a comprehensive overview of the cardiac anatomy, technical aspects to optimize the safety of epicardial puncture, recognize and avoid potential complications.
ISSN:1045-3873
1540-8167
DOI:10.1111/jce.15101