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Our Approach to Minimize Risk of Epicardial Access: Standard Techniques with the Addition of Electroanatomic Mapping Guidance

Authors

  • JASON S. BRADFIELD M.D.,

    1. UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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  • RODERICK TUNG M.D.,

    1. UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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  • NOEL G. BOYLE M.D., Ph.D.,

    1. UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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  • ERIC BUCH M.D.,

    1. UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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  • KALYANAM SHIVKUMAR M.D., Ph.D.

    Corresponding author
    • UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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  • The University of California, Los Angeles has intellectual property developed by the authors that relates to epicardial interventions.

  • Dr. Shivkumar receives grant support from the National Heart Lung and Blood Institute (R01HL084261).

  • No other disclosures.

Address for correspondence: Kalyanam Shivkumar, M.D., Ph.D., UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA. Fax: 310-794-6492; E-mail: KShivkumar@mednet.ucla.edu

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.

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