Experimental Efficacy of Pericardial Instillation of Anti-inflammatory Agents during Percutaneous Epicardial Catheter Ablation to Prevent Postprocedure Pericarditis

Introduction: Pericarditis is a potential complication of catheter‐based percutaneous epicardial mapping and ablation. This study evaluates the efficacy and safety of intrapericardial instillation of anti‐inflammatory agents after pericardial mapping and ablation in a porcine model of postprocedural...

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Bibliographic Details
Published in:Journal of cardiovascular electrophysiology 2007-11, Vol.18 (11), p.1178-1183
Main Authors: D'AVILA, ANDRE, NEUZIL, PETR, THIAGALINGAM, ARAVINDA, GUTIERREZ, PAULO, ALEONG, RYAN, RUSKIN, JEREMY N., REDDY, VIVEK Y.
Format: Article
Language:English
Subjects:
Animals
Anti-Inflammatory Agents - administration & dosage
catheter ablation
Catheter Ablation - adverse effects
Catheter Ablation - methods
Disease Models, Animal
epicardium
Instillation, Drug
pericarditis
Pericarditis - etiology
Pericarditis - pathology
Pericarditis - prevention & control
Pericardium
radiofrequency
Swine
Treatment Outcome
Triamcinolone - administration & dosage
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Summary:Introduction: Pericarditis is a potential complication of catheter‐based percutaneous epicardial mapping and ablation. This study evaluates the efficacy and safety of intrapericardial instillation of anti‐inflammatory agents after pericardial mapping and ablation in a porcine model of postprocedural pericarditis. Methods and Results: Twenty‐five healthy swine underwent epicardial mapping and ablation after transthoracic subxyphoid puncture. After 60 minutes of continuous catheter manipulation in the pericardial space, radiofrequency energy was delivered in a linear fashion to the epicardial surfaces of both atria. The animals were randomly divided to receive the anti‐inflammatory agents, Hyaluronic Acid and Triamcinolone, or control. Fourteen days after ablation, the hearts were excised and the degree of pericardial reaction/adhesions scored. The severity was uniformly graded 4 (intense) in all control animals and was characterized by intense adhesion between the parietal and the visceral pericardium obscuring tissue planes and epicardial anatomy. Hyaluronic Acid provided a mild benefit (score 3.0 ± 0.9), but 2 mg/kg of Triamcinolone significantly attenuated the inflammatory effect (all animals uniformly scored 1.0). Conclusion: In a porcine model of ablation‐related pericarditis, intrapericardial instillation of 2 mg/kg of intermediate‐acting corticosteroids effectively prevents post‐procedure inflammatory adhesion formation.
ISSN:1045-3873
1540-8167
DOI:10.1111/j.1540-8167.2007.00945.x