This work was supported in part by a FAPESP award 02/09116-7 to Dr. d' Avila and an NIH K23 award (HL68064) to Dr. Reddy.
Experimental Efficacy of Pericardial Instillation of Anti-inflammatory Agents during Percutaneous Epicardial Catheter Ablation to Prevent Postprocedure Pericarditis
Article first published online: 20 SEP 2007
Journal of Cardiovascular Electrophysiology
Volume 18, Issue 11, pages 1178–1183, November 2007
How to Cite
D'AVILA, A., NEUZIL, P., THIAGALINGAM, A., GUTIERREZ, P., ALEONG, R., RUSKIN, J. N. and REDDY, V. Y. (2007), Experimental Efficacy of Pericardial Instillation of Anti-inflammatory Agents during Percutaneous Epicardial Catheter Ablation to Prevent Postprocedure Pericarditis. Journal of Cardiovascular Electrophysiology, 18: 1178–1183. doi: 10.1111/j.1540-8167.2007.00945.x
Presented as an abstract at the 28th Annual Scientific Sessions of the Heart Rhythm Society, May 10, 2007, Denver, Colorado.
Manuscript received 2 June 2007; Revised manuscript received 18 June 2007; Accepted for publication 29 June 2007.
- Issue published online: 18 OCT 2007
- Article first published online: 20 SEP 2007
- catheter ablation;
Introduction: Pericarditis is a potential complication of catheter-based percutaneous epicardial mapping and ablation. This study evaluates the efficacy and safety of intrapericardial instillation of anti-inflammatory agents after pericardial mapping and ablation in a porcine model of postprocedural pericarditis.
Methods and Results: Twenty-five healthy swine underwent epicardial mapping and ablation after transthoracic subxyphoid puncture. After 60 minutes of continuous catheter manipulation in the pericardial space, radiofrequency energy was delivered in a linear fashion to the epicardial surfaces of both atria. The animals were randomly divided to receive the anti-inflammatory agents, Hyaluronic Acid and Triamcinolone, or control. Fourteen days after ablation, the hearts were excised and the degree of pericardial reaction/adhesions scored. The severity was uniformly graded 4 (intense) in all control animals and was characterized by intense adhesion between the parietal and the visceral pericardium obscuring tissue planes and epicardial anatomy. Hyaluronic Acid provided a mild benefit (score 3.0 ± 0.9), but 2 mg/kg of Triamcinolone significantly attenuated the inflammatory effect (all animals uniformly scored 1.0).
Conclusion: In a porcine model of ablation-related pericarditis, intrapericardial instillation of 2 mg/kg of intermediate-acting corticosteroids effectively prevents post-procedure inflammatory adhesion formation.