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Epicardial access facilitated by carbon dioxide insufflation via intentional coronary vein exit: step-by-step description of the technique and review of the literature

Abstract

Pericardial access from a subxiphoid approach is often necessary to gain access to a critical epicardial substrate that is inaccessible from the endocardium. Although relatively safe, a rate of up to 5% of acute and 2% delayed complications has been reported. Intentional perforation of a distal coronary vein branch with pericardial insufflation of CO2 to create a negative contrast space anterior to the right ventricle is an emerging approach to facilitate pericardial access. In this report, we describe the technique of intentional coronary vein exit with CO2 insufflation to perform epicardial mapping and ablation of ventricular tachycardia (VT) in a step-by-step approach and review the published literature on this topic.

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Funding

This study was partially supported by the Winkelman Family Fund in Cardiovascular Innovation and the Pennsylvania Steel Company EP Research Fund. The funder played no role in the conduct of the study, preparation of the manuscript, or the decision to submit the publication.

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Correspondence to Pasquale Santangeli.

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All patients provided written informed consent for both the ablation procedure and inclusion in a registry approved by the University of Pennsylvania Health System’s Institutional Review Board.

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The authors declare no competing interests.

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Cerantola, M., Santangeli, P. Epicardial access facilitated by carbon dioxide insufflation via intentional coronary vein exit: step-by-step description of the technique and review of the literature. J Interv Card Electrophysiol (2022). https://doi.org/10.1007/s10840-022-01338-2

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  • DOI: https://doi.org/10.1007/s10840-022-01338-2

Keywords

  • Catheter ablation
  • Pericardial access
  • Ventricular tachycardia
  • CO2 insufflation
  • Intentional coronary vein exit