Shibu Mathew1,2, Sebastian Feickert3, Thomas Fink3,4, Andreas Rillig3,5, Bruno Reissmann3,5, Laura Rottner3,5, Naotaka Hashiguchi3, Peter Wohlmuth6, Tilman Maurer3, Christine Lemes3, Andreas Metzner3,5, Karl-Heinz Kuck3, Feifan Ouyang3,7. 1. Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. dr.mathew.shibu@googlemail.com. 2. Department of Cardiology, University Hospital of Giessen, Klinikstrasse 33, 35392, Giessen, Germany. dr.mathew.shibu@googlemail.com. 3. Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. 4. University Heart Center Lübeck, Medical Clinic II, University Hospital Schleswig Holstein, Lübeck, Germany. 5. University Heart Center Hamburg, Department of Electrophysiology, University Hospital Hamburg Eppendorf, Hamburg, Germany. 6. Asklepios Proresearch, Hamburg, Germany. 7. Fuwai Hospital/National Centers of Cardiovascular Diseases, The Chinese Academy of Medical Sciences and National Center of Cardiovascular Diseases, Beijing, China.
Abstract
INTRODUCTION: Pericardial access for ablation of ventricular arrhythmias (VA) can be gained either by an anterior-oriented or inferior-oriented epicardial puncture under fluoroscopical guidance. We retrospectively sought to assess the safety of these two puncture techniques and the incidence of epicardial adhesions and introduce our algorithm for management of pericardial tamponade. METHODS AND RESULTS: In 211 patients (61.4 ± 15.6 years, 179 males; 84.8%) 271 epicardial ablation procedures of VA were performed using either an anterior- or inferior-oriented approach for epicardial access. Puncture-related complications were systematically analyzed. Furthermore, the incidence of adhesions was evaluated during first and repeated procedures. A total of 34/271 (12.5%) major complications occurred and 23/271 (8.5%) were directly related to epicardial puncture. The incidence of puncture-related major complications in the anterior and inferior group was 4/82 (4.9%) and 19/189 (10.1%), respectively. Pericardial tamponade was the most common major complication (15/271; 5.5%). Collateral damages of adjacent structures such as liver, colon, gastric vessels and coronary arteries occurred in 6/189 (3.2%) patients and only within the inferior epicardial access group. Adhesions were documented in 19/211 (9%) patients during the first procedure and in 47.1% if patients had 2 or more procedures involving epicardial access. CONCLUSION: Anterior-oriented epicardial puncture shows an observed association to a reduced incidence of pericardial tamponades and overall puncture-related complications in epicardial ablation of VA. In cases of repeated epicardial access adhesions increase significantly and may lead to ablation failure.
INTRODUCTION: Pericardial access for ablation of ventricular arrhythmias (VA) can be gained either by an anterior-oriented or inferior-oriented epicardial puncture under fluoroscopical guidance. We retrospectively sought to assess the safety of these two puncture techniques and the incidence of epicardial adhesions and introduce our algorithm for management of pericardial tamponade. METHODS AND RESULTS: In 211 patients (61.4 ± 15.6 years, 179 males; 84.8%) 271 epicardial ablation procedures of VA were performed using either an anterior- or inferior-oriented approach for epicardial access. Puncture-related complications were systematically analyzed. Furthermore, the incidence of adhesions was evaluated during first and repeated procedures. A total of 34/271 (12.5%) major complications occurred and 23/271 (8.5%) were directly related to epicardial puncture. The incidence of puncture-related major complications in the anterior and inferior group was 4/82 (4.9%) and 19/189 (10.1%), respectively. Pericardial tamponade was the most common major complication (15/271; 5.5%). Collateral damages of adjacent structures such as liver, colon, gastric vessels and coronary arteries occurred in 6/189 (3.2%) patients and only within the inferior epicardial access group. Adhesions were documented in 19/211 (9%) patients during the first procedure and in 47.1% if patients had 2 or more procedures involving epicardial access. CONCLUSION: Anterior-oriented epicardial puncture shows an observed association to a reduced incidence of pericardial tamponades and overall puncture-related complications in epicardial ablation of VA. In cases of repeated epicardial access adhesions increase significantly and may lead to ablation failure.
Authors: Kristina Wasmer; Holger Reinecke; Marius Heitmann; Dirk G Dechering; Florian Reinke; Philipp S Lange; Gerrit Frommeyer; Simon Kochhäuser; Patrick Leitz; Lars Eckardt; Julia Köbe Journal: Clin Res Cardiol Date: 2020-03-10 Impact factor: 5.460
Authors: David Duncker; Philipp Sommer; Sonia Busch; Roland R Tilz; Till Althoff; Leon Iden; Andreas Metzner; Andreas Rillig; K R Julian Chun; Felix Bourier; Tilman Maurer; Dong-In Shin Journal: Herzschrittmacherther Elektrophysiol Date: 2021-05-19