Successful percutaneous epicardial access in challenging scenarios

Elisa Ebrille, Ammar M. Killu, Nandan S. Anavekar, Douglas L Packer, Thomas M. Munger, Christopher J. McLeod, Samuel J Asirvatham, Paul Andrew Friedman

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background This case-series highlights strategies used for successful epicardial access in challenging cases. Percutaneous epicardial access has become a valuable tool for mapping and ablating arrhythmias. However, this technique can be especially difficult in certain circumstances and is frequently avoided. Methods All cases of epicardial access for ablation from our institution were reviewed searching for exceptionally difficult cases in patients with complex pericardial and thoracic anatomy. The successful strategies are characterized in this report. Results Among 144 patients who underwent an epicardial ablation procedure between January 2004 and June 2013, four required unconventional approaches for epicardial access for ventricular tachycardia ablation. Two patients (one with previous cardiac surgery and one with prior pericardial effusion) had substantial fibrous pericardial adhesions with no virtual pericardial space and required adhesiolysis. One patient, status postpartial colectomy, underwent computed tomography-guided intercostal epicardial access due to the presence of bowel throughout the subdiaphragmatic space in the upper abdomen. The fourth patient had partial congenital absence of the pericardium and underwent epicardial access through the creation of a subxiphoid window. All epicardial accesses were successful and performed without major complication. Conclusions With precise procedural planning and cardiac imaging, percutaneous epicardial access is feasible even in patients with significant anatomical challenges.

Original languageEnglish (US)
Pages (from-to)84-90
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Volume38
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Pericardium
Pericardial Effusion
Colectomy
Ventricular Tachycardia
Abdomen
Thoracic Surgery
Cardiac Arrhythmias
Anatomy
Thorax
Tomography

Keywords

  • ablation
  • challenging
  • epicardial access
  • percutaneous
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Successful percutaneous epicardial access in challenging scenarios. / Ebrille, Elisa; Killu, Ammar M.; Anavekar, Nandan S.; Packer, Douglas L; Munger, Thomas M.; McLeod, Christopher J.; Asirvatham, Samuel J; Friedman, Paul Andrew.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 38, No. 1, 01.01.2015, p. 84-90.

Research output: Contribution to journalArticle

Ebrille, Elisa ; Killu, Ammar M. ; Anavekar, Nandan S. ; Packer, Douglas L ; Munger, Thomas M. ; McLeod, Christopher J. ; Asirvatham, Samuel J ; Friedman, Paul Andrew. / Successful percutaneous epicardial access in challenging scenarios. In: PACE - Pacing and Clinical Electrophysiology. 2015 ; Vol. 38, No. 1. pp. 84-90.
@article{07ac10d650c1411395d020c30880d43a,
title = "Successful percutaneous epicardial access in challenging scenarios",
abstract = "Background This case-series highlights strategies used for successful epicardial access in challenging cases. Percutaneous epicardial access has become a valuable tool for mapping and ablating arrhythmias. However, this technique can be especially difficult in certain circumstances and is frequently avoided. Methods All cases of epicardial access for ablation from our institution were reviewed searching for exceptionally difficult cases in patients with complex pericardial and thoracic anatomy. The successful strategies are characterized in this report. Results Among 144 patients who underwent an epicardial ablation procedure between January 2004 and June 2013, four required unconventional approaches for epicardial access for ventricular tachycardia ablation. Two patients (one with previous cardiac surgery and one with prior pericardial effusion) had substantial fibrous pericardial adhesions with no virtual pericardial space and required adhesiolysis. One patient, status postpartial colectomy, underwent computed tomography-guided intercostal epicardial access due to the presence of bowel throughout the subdiaphragmatic space in the upper abdomen. The fourth patient had partial congenital absence of the pericardium and underwent epicardial access through the creation of a subxiphoid window. All epicardial accesses were successful and performed without major complication. Conclusions With precise procedural planning and cardiac imaging, percutaneous epicardial access is feasible even in patients with significant anatomical challenges.",
keywords = "ablation, challenging, epicardial access, percutaneous, ventricular tachycardia",
author = "Elisa Ebrille and Killu, {Ammar M.} and Anavekar, {Nandan S.} and Packer, {Douglas L} and Munger, {Thomas M.} and McLeod, {Christopher J.} and Asirvatham, {Samuel J} and Friedman, {Paul Andrew}",
year = "2015",
month = "1",
day = "1",
doi = "10.1111/pace.12503",
language = "English (US)",
volume = "38",
pages = "84--90",
journal = "PACE - Pacing and Clinical Electrophysiology",
issn = "0147-8389",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Successful percutaneous epicardial access in challenging scenarios

AU - Ebrille, Elisa

AU - Killu, Ammar M.

AU - Anavekar, Nandan S.

AU - Packer, Douglas L

AU - Munger, Thomas M.

AU - McLeod, Christopher J.

AU - Asirvatham, Samuel J

AU - Friedman, Paul Andrew

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background This case-series highlights strategies used for successful epicardial access in challenging cases. Percutaneous epicardial access has become a valuable tool for mapping and ablating arrhythmias. However, this technique can be especially difficult in certain circumstances and is frequently avoided. Methods All cases of epicardial access for ablation from our institution were reviewed searching for exceptionally difficult cases in patients with complex pericardial and thoracic anatomy. The successful strategies are characterized in this report. Results Among 144 patients who underwent an epicardial ablation procedure between January 2004 and June 2013, four required unconventional approaches for epicardial access for ventricular tachycardia ablation. Two patients (one with previous cardiac surgery and one with prior pericardial effusion) had substantial fibrous pericardial adhesions with no virtual pericardial space and required adhesiolysis. One patient, status postpartial colectomy, underwent computed tomography-guided intercostal epicardial access due to the presence of bowel throughout the subdiaphragmatic space in the upper abdomen. The fourth patient had partial congenital absence of the pericardium and underwent epicardial access through the creation of a subxiphoid window. All epicardial accesses were successful and performed without major complication. Conclusions With precise procedural planning and cardiac imaging, percutaneous epicardial access is feasible even in patients with significant anatomical challenges.

AB - Background This case-series highlights strategies used for successful epicardial access in challenging cases. Percutaneous epicardial access has become a valuable tool for mapping and ablating arrhythmias. However, this technique can be especially difficult in certain circumstances and is frequently avoided. Methods All cases of epicardial access for ablation from our institution were reviewed searching for exceptionally difficult cases in patients with complex pericardial and thoracic anatomy. The successful strategies are characterized in this report. Results Among 144 patients who underwent an epicardial ablation procedure between January 2004 and June 2013, four required unconventional approaches for epicardial access for ventricular tachycardia ablation. Two patients (one with previous cardiac surgery and one with prior pericardial effusion) had substantial fibrous pericardial adhesions with no virtual pericardial space and required adhesiolysis. One patient, status postpartial colectomy, underwent computed tomography-guided intercostal epicardial access due to the presence of bowel throughout the subdiaphragmatic space in the upper abdomen. The fourth patient had partial congenital absence of the pericardium and underwent epicardial access through the creation of a subxiphoid window. All epicardial accesses were successful and performed without major complication. Conclusions With precise procedural planning and cardiac imaging, percutaneous epicardial access is feasible even in patients with significant anatomical challenges.

KW - ablation

KW - challenging

KW - epicardial access

KW - percutaneous

KW - ventricular tachycardia

UR - http://www.scopus.com/inward/record.url?scp=84920816852&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84920816852&partnerID=8YFLogxK

U2 - 10.1111/pace.12503

DO - 10.1111/pace.12503

M3 - Article

VL - 38

SP - 84

EP - 90

JO - PACE - Pacing and Clinical Electrophysiology

JF - PACE - Pacing and Clinical Electrophysiology

SN - 0147-8389

IS - 1

ER -