Our approach to minimize risk of epicardial access: Standard techniques with the addition of electroanatomic mapping guidance

Jason S. Bradfield, Roderick Tung, Noel G. Boyle, Eric Buch, Kalyanam Shivkumar

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Epicardial Access Techniques Epicardial mapping and ablation is increasingly being performed for the treatment of complex arrhythmias. Right ventricular (RV) puncture remains the most common complication, with damage to surrounding non-cardiac structures also a concern. We describe the standard techniques used in our lab essential for safe epicardial access, as well as a novel technique incorporating electroanatomic mapping (EAM) guidance. In a series of 8 patients referred for ventricular tachycardia ablation, an RV endocardial voltage map was created using EAM systems. EAM images were fused with preprocedure CT scans when available. A 17G Tuohy needle was integrated with the EAM system by attaching the needle to sterile electrode clamps. EAM location points were used in conjunction with standard access techniques until epicardial access was obtained. Epicardial access was successfully obtained in 8/8 (100%) patients. Successful access without RV puncture was achieved in 7/8 (88%) cases. This proof of concept study demonstrates that EAM systems can be used as an adjunct to standard access techniques to visualize and facilitate pericardial access.

Original languageEnglish (US)
Pages (from-to)723-727
Number of pages5
JournalJournal of cardiovascular electrophysiology
Volume24
Issue number6
DOIs
StatePublished - Jun 2013
Externally publishedYes

Keywords

  • catheter ablation
  • electroanatomic mapping
  • epicardial ablation
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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