Skip to main content
SpringerLink
Log in

Significance and clinical characteristics of atrial fibrillation post epicardial access

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Introduction

Epicardial access (EpiAcc) has become an important adjunct for ventricular tachycardia (VT) or premature ventricular complex (PVC) ablation. We hypothesized that post-procedural pericarditis may lead to an increased risk of atrial fibrillation (AF), and therefore assessed the incidence and clinical impact of post-procedural AF in patients undergoing EpiAcc.

Methods

We reviewed the records of all patients who underwent EpiAcc as part of an ablation procedure between January 1, 2004 and July 31, 2014 at Mayo Clinic Rochester. AF occurrence was determined by clinical documentation or electrocardiographic recordings post procedure.

Results

Epicardial access was obtained in 170 pts (indication 110 VT and 60 PVC). The mean age was 53 ± 16 years and 122 (72%) were male. Seven (4.1%) patients developed AF within 7 days of the procedure, at a mean of 49 ± 18 h post procedure; it was paroxysmal in all patients with an average duration 6.0 ± 5.5 h (range 2–18). All patients spontaneously converted to sinus rhythm; but 3 needed rate control with AV nodal blockade (calcium channel blockers [n = 2] or beta blockers [n = 1]). One patient out of 60 who received intrapericardial steroids developed AF (2%), while of the 110 who did not receive steroids, 6 developed AF (5%) (p = 0.42). During average follow-up 2.3 years, there were no documented recurrences of atrial fibrillation in these patients.

Conclusion

Atrial fibrillation following epicardial access is infrequent. When it occurs, it tends to be paroxysmal in nature and without severe symptoms. Administration of intrapericardial steroids did not affect the rate of AF post procedure; further studies however are needed to define their role.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sacher F, Tedrow UB, Field ME, Raymond JM, Koplan BA, Epstein LM, et al. Ventricular tachycardia ablation: evolution of patients and procedures over 8 years. Circ Arrhythm Electrophysiol. 2008;1:153–61.

    Article  PubMed  Google Scholar 

  2. Soejima K, Stevenson WG, Sapp JL, Selwyn AP, Couper G, Epstein LM. Endocardial and epicardial radiofrequency ablation of ventricular tachycardia associated with dilated cardiomyopathy: the importance of low-voltage scars. J Am Coll Cardiol. 2004;43:1834–42.

    Article  PubMed  Google Scholar 

  3. Garcia FC, Bazan V, Zado ES, Ren JF, Marchlinski FE. Epicardial substrate and outcome with epicardial ablation of ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circulation. 2009;120:366–75.

    Article  PubMed  Google Scholar 

  4. Tung R, Michowitz Y, Yu R, Mathuria N, Vaseghi M, Buch E, et al. Epicardial ablation of ventricular tachycardia: an institutional experience of safety and efficacy. Heart Rhythm. 2013;10:490–8.

    Article  PubMed  Google Scholar 

  5. Dyrda K, Piers SR, van Huls van Taxis CF, Schalij MJ, Zeppenfeld K. Influence of steroid therapy on the incidence of pericarditis and atrial fibrillation after percutaneous epicardial mapping and ablation for ventricular tachycardia. Circ Arrhythm Electrophysiol. 2014;7:671–6.

    Article  CAS  PubMed  Google Scholar 

  6. Mahapatra S, LaPar DJ, Bhamidipati CM, McDaniel G, Kamath S, Bunch TJ, et al. Incidence, risk factors, and consequences of new-onset atrial fibrillation following epicardial ablation for ventricular tachycardia. Europace. 2011;13:548–54.

    Article  PubMed  PubMed Central  Google Scholar 

  7. d’Avila A, Neuzil P, Thiagalingam A, Gutierrez P, Aleong R, Ruskin JN, et al. Experimental efficacy of pericardial instillation of anti-inflammatory agents during percutaneous epicardial catheter ablation to prevent postprocedure pericarditis. J Cardiovasc Electrophysiol. 2007;18:1178–83.

    Article  PubMed  Google Scholar 

  8. Sosa E, Scanavacca M, d’Avila A, Pilleggi F. A new technique to perform epicardial mapping in the electrophysiology laboratory. J Cardiovasc Electrophysiol. 1996;7:531–6.

    Article  CAS  PubMed  Google Scholar 

  9. Killu AM, Ebrille E, Asirvatham SJ, Munger TM, McLeod CJ, Packer DL, et al. Percutaneous epicardial access for mapping and ablation is feasible in patients with prior cardiac surgery, including coronary bypass surgery. Circ Arrhythm Electrophysiol. 2015;8:94–101.

    Article  PubMed  Google Scholar 

  10. Mariscalco G, Klersy C, Zanobini M, Banach M, Ferrarese S, Borsani P, et al. Atrial fibrillation after isolated coronary surgery affects late survival. Circulation. 2008;118:1612–8.

    Article  PubMed  Google Scholar 

  11. Imazio M, Lazaros G, Picardi E, Vasileiou P, Orlando F, Carraro M, et al. Incidence and prognostic significance of new onset atrial fibrillation/flutter in acute pericarditis. Heart. 2015;101:1463–7.

    Article  CAS  PubMed  Google Scholar 

  12. Spodick DH. Arrhythmias during acute pericarditis. A prospective study of 100 consecutive cases. JAMA. 1976;235:39–41.

    Article  CAS  PubMed  Google Scholar 

  13. James TN. Pericarditis and the sinus node. Arch Intern Med. 1962;110:305–11.

    Article  CAS  PubMed  Google Scholar 

  14. Viskin S, Golovner M, Malov N, Fish R, Alroy I, Vila Y, et al. Circadian variation of symptomatic paroxysmal atrial fibrillation. Data from almost 10 000 episodes. Eur Heart J. 1999;20:1429–34.

    Article  CAS  PubMed  Google Scholar 

  15. Richer LP, Vinet A, Kus T, Cardinal R, Ardell JL, Armour JA. Alpha-adrenoceptor blockade modifies neurally induced atrial arrhythmias. Am J Physiol Regul Integr Comp Physiol. 2008;295:R1175–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Chen PS, Chen LS, Fishbein MC, Lin SF, Nattel S. Role of the autonomic nervous system in atrial fibrillation: pathophysiology and therapy. Circ Res. 2014;114:1500–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Dewland TA, Vittinghoff E, Harris TB, Magnani JW, Liu Y, Hsu FC, et al. Inflammation as a mediator of the association between race and atrial fibrillation: results from the health, aging, and body composition study. JACC Clin Electrophysiol. 2015;1:248–55.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ommen SR, Odell JA, Stanton MS. Atrial arrhythmias after cardiothoracic surgery. N Engl J Med. 1997;336:1429–34.

    Article  CAS  PubMed  Google Scholar 

  19. Bruins P, te Velthuis H, Yazdanbakhsh AP, Jansen PG, van Hardevelt FW, de Beaumont EM, et al. Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia. Circulation. 1997;96:3542–8.

    Article  CAS  PubMed  Google Scholar 

  20. Imazio M, Brucato A, Ferrazzi P, Rovere ME, Gandino A, Cemin R, et al. Colchicine reduces postoperative atrial fibrillation: results of the Colchicine for the Prevention of the Postpericardiotomy Syndrome (COPPS) atrial fibrillation substudy. Circulation. 2011;124:2290–5.

    Article  CAS  PubMed  Google Scholar 

  21. Imazio M, Brucato A, Ferrazzi P, Pullara A, Adler Y, Barosi A, et al. Colchicine for prevention of postpericardiotomy syndrome and postoperative atrial fibrillation: the COPPS-2 randomized clinical trial. JAMA. 2014;312:1016–23.

    Article  CAS  PubMed  Google Scholar 

  22. Tabbalat RA, Hamad NM, Alhaddad IA, Hammoudeh A, Akasheh BF, Khader Y. Effect of ColchiciNe on the InciDence of Atrial fibrillation in open heart surgery patients: END-AF trial. Am Heart J. 2016;178:102–7.

    Article  PubMed  Google Scholar 

  23. Yancy CW, Lopatin M, Stevenson LW, De Marco T, Fonarow GC, Committee ASA and Investigators. Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) database. J Am Coll Cardiol. 2006;47:76–84.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Alan Sugrue

  2. Division of Cardiovascular Diseases, Mayo Clinic, 200 1st SW, Rochester, MN, USA

    Ammar M. Killu, David O. Hodge, Christopher J. McLeod, Thomas M. Munger, Siva K. Mulpuru, Douglas L. Packer, Suraj Kapa, Samuel J. Asirvatham & Paul A. Friedman

  3. Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA

    Samuel J. Asirvatham

Authors
  1. Alan Sugrue
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ammar M. Killu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David O. Hodge
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christopher J. McLeod
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas M. Munger
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Siva K. Mulpuru
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Douglas L. Packer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Suraj Kapa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Samuel J. Asirvatham
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Paul A. Friedman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ammar M. Killu.

Additional information

Alan Sugrue and Ammar M. Killu are co-primary authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sugrue, A., Killu, A.M., Hodge, D.O. et al. Significance and clinical characteristics of atrial fibrillation post epicardial access. J Interv Card Electrophysiol 48, 141–146 (2017). https://doi.org/10.1007/s10840-016-0215-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-016-0215-5

Keywords

Search

Navigation