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Current and novel percutaneous epicardial access techniques for electrophysiological interventions: A comparison of procedural success and safety

Tonko, Johanna B; Lambiase, Pier D; (2023) Current and novel percutaneous epicardial access techniques for electrophysiological interventions: A comparison of procedural success and safety. Journal of Cardiovascular Electrophysiology 10.1111/jce.16069. (In press). Green open access

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Abstract

Accessing the pericardial space safely and efficiently is an important skill for interventional cardiac electrophysiologist. With the increased recognition of the complexity of the 3-dimensional arrhythmogenic substrate due to advances in imaging and mapping technologies there has been an expansion of epicardial procedures in recent years. Equally, minimally invasive implantation of epicardial pacing, cardiac resynchronization, or defibrillation leads is expanding in specific patients where transvenous systems are contraindicated or their long term sequelae should be ideally avoided. Selective delivery of intrapericardial pharmacological antiarrhythmic therapy is yet another potential indication, albeit still investigational. The expanding indications for percutaneous epicardial procedures is contrasted by the still substantial risk and challenges associated with accessing the pericardial space. Myocardial perforation, coronary artery laceration, and damage to the surrounding organs are all recognized and feared complications. A number of innovative epicardial access techniques have been proposed to overcome the difficulties and risks of traditional dry subxiphoid punctures and may allow for more widespread use of epicardial access in the future. We review 10 different established and novel subxiphoidal epicardial access techniques describing procedural success rates, safety profile and overall experience. The technical aspects as well as access times and costs for extra equipment will be reviewed. Finally, an outlook of reported preclinical techniques awaiting in-human feasibility studies is provided.

Type: Article
Title: Current and novel percutaneous epicardial access techniques for electrophysiological interventions: A comparison of procedural success and safety
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/jce.16069
Publisher version: https://doi.org/10.1111/jce.16069
Language: English
Additional information: Copyright © 2023 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, https://creativecommons.org/licenses/by-nc/4.0/, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Keywords: Epicardial access, epicardial mapping, needle‐in‐needle puncture, pericardial adhesions, pericardial carbon dioxid insufflation, pericardiostomy, subxiphoid puncture
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
URI: https://discovery.ucl.ac.uk/id/eprint/10178769
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