Significance and clinical characteristics of atrial fibrillation post epicardial access

Introduction: Epicardial access (EpiAcc) has become an important adjunct for ventricular tachycardia (VT) or premature ventricular complex (PVC) ablation. We hypothesized that post-procedural pericarditis may lead to an increased risk of atrial fibrillation (AF), and therefore assessed the incidence and clinical impact of post-procedural AF in patients undergoing EpiAcc. Methods: We reviewed the records of all patients who underwent EpiAcc as part of an ablation procedure between January 1, 2004 and July 31, 2014 at Mayo Clinic Rochester. AF occurrence was determined by clinical documentation or electrocardiographic recordings post procedure. Results: Epicardial access was obtained in 170 pts (indication 110 VT and 60 PVC). The mean age was 53 ± 16 years and 122 (72%) were male. Seven (4.1%) patients developed AF within 7 days of the procedure, at a mean of 49 ± 18 h post procedure; it was paroxysmal in all patients with an average duration 6.0 ± 5.5 h (range 2–18). All patients spontaneously converted to sinus rhythm; but 3 needed rate control with AV nodal blockade (calcium channel blockers [n = 2] or beta blockers [n = 1]). One patient out of 60 who received intrapericardial steroids developed AF (2%), while of the 110 who did not receive steroids, 6 developed AF (5%) (p = 0.42). During average follow-up 2.3 years, there were no documented recurrences of atrial fibrillation in these patients. Conclusion: Atrial fibrillation following epicardial access is infrequent. When it occurs, it tends to be paroxysmal in nature and without severe symptoms. Administration of intrapericardial steroids did not affect the rate of AF post procedure; further studies however are needed to define their role.