The University of California, Los Angeles has intellectual property developed by the authors that relates to epicardial interventions.
TECHNIQUES AND TECHNOLOGY
Our Approach to Minimize Risk of Epicardial Access: Standard Techniques with the Addition of Electroanatomic Mapping Guidance
Article first published online: 21 DEC 2012
© 2012 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 24, Issue 6, pages 723–727, June 2013
How to Cite
BRADFIELD, J. S., TUNG, R., BOYLE, N. G., BUCH, E. and SHIVKUMAR, K. (2013), Our Approach to Minimize Risk of Epicardial Access: Standard Techniques with the Addition of Electroanatomic Mapping Guidance. Journal of Cardiovascular Electrophysiology, 24: 723–727. doi: 10.1111/jce.12058
Dr. Shivkumar receives grant support from the National Heart Lung and Blood Institute (R01HL084261).
No other disclosures.
- Issue published online: 4 JUN 2013
- Article first published online: 21 DEC 2012
- Accepted manuscript online: 21 NOV 2012 03:55PM EST
- Manuscript Accepted: 5 NOV 2012
- Manuscript Revised: 31 OCT 2012
- Manuscript Received: 30 SEP 2012
- National Heart Lung and Blood Institute. Grant Number: R01HL084261
- catheter ablation;
- electroanatomic mapping;
- epicardial ablation;
- ventricular tachycardia
Epicardial Access Techniques
Epicardial mapping and ablation is increasingly being performed for the treatment of complex arrhythmias. Right ventricular (RV) puncture remains the most common complication, with damage to surrounding non-cardiac structures also a concern. We describe the standard techniques used in our lab essential for safe epicardial access, as well as a novel technique incorporating electroanatomic mapping (EAM) guidance. In a series of 8 patients referred for ventricular tachycardia ablation, an RV endocardial voltage map was created using EAM systems. EAM images were fused with preprocedure CT scans when available. A 17G Tuohy needle was integrated with the EAM system by attaching the needle to sterile electrode clamps. EAM location points were used in conjunction with standard access techniques until epicardial access was obtained. Epicardial access was successfully obtained in 8/8 (100%) patients. Successful access without RV puncture was achieved in 7/8 (88%) cases. This proof of concept study demonstrates that EAM systems can be used as an adjunct to standard access techniques to visualize and facilitate pericardial access.