Abstract
Purpose
Percutaneous pericardial access (EpiAcc) assists ventricular tachycardia/premature ventricular complex (VT/PVC) ablation by permitting epicardial mapping and ablation outside the vicinity of the coronary venous system. We sought to determine whether expanding indications and growing operator experience have led to increased rates of EpiAcc.
Methods
We reviewed the frequency of EpiAcc procedures performed during VT/PVC ablation between 2007 and 2014 to identify temporal trends in the procedure.
Results
There were 758 patients undergoing 880 VT/PVC ablation procedures (average 95 patients per year; 110 procedures per year) during the study period. EpiAcc for ablation was utilized in 170 patients (181 procedures). The average age at the time of EpiAcc was 55 ± 16 years and 129 (76.0 %) patients were male. The rate of EpiAcc was 22.9 % in males and 15.4 % in females (P = 0.008). The absolute number of EpiAcc procedures increased from 2007 (6 procedures) to 2014 (27 procedures). Similarly, the proportion of patients undergoing EpiAcc increased from 8.6 % of procedures in 2007 to 24.5 % in 2014 (P < 0.0001). While EpiAcc use became more frequent, the rate of epicardial ablation among those who underwent EpiAcc remained stable (approximately 70 %).
Conclusions
Percutaneous pericardial access has been used with increasing frequency as part of VT/PVC ablations without an increase in the rate of epicardial ablation. This growing utilization may lay the foundation for novel epicardial strategies as new technologies emerge. The frequency of percutaneous pericardial access in VT/PVC ablation appears to be greater in males, reasons for which are undefined.
Similar content being viewed by others
References
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(6):531–6.
Sacher F, Roberts-Thomson K, Maury P, Tedrow U, Nault I, Steven D, et al. Epicardial ventricular tachycardia ablation a multicenter safety study. [Comparative Study Multicenter Study Research Support, Non-U.S. Gov’t]. J Am Coll Cardiol. 2010;55(21):2366–72.
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. [Comparative Study]. Heart Rhythm. 2013;10(4):490–8.
Aliot EM, Stevenson WG, Almendral-Garrote JM, Bogun F, Calkins CH, Delacretaz E, et al. EHRA/HRS expert consensus on catheter ablation of ventricular arrhythmias: developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). [News]. Heart Rhythm. 2009;6(6):886–933.
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. [Evaluation Studies]. Circ Arrhythmia Electrophysiol. 2015;8(1):94–101.
Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the Task Force Criteria. [Consensus Development Conference Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t]. Eur Heart J. 2010;31(7):806–14.
Kumar S, Bazaz R, Barbhaiya CR, Enriquez AD, Helmbold AF, Chinitz JS, et al. “Needle-in-needle” epicardial access: preliminary observations with a modified technique for facilitating epicardial interventional procedures. [Research Support, Non-U.S. Gov’t]. Heart Rhythm. 2015;12(7):1691–7.
Di Biase L, Burkhardt JD, Pelargonio G, Dello Russo A, Casella M, Santarelli P, et al. Prevention of phrenic nerve injury during epicardial ablation: comparison of methods for separating the phrenic nerve from the epicardial surface. [Clinical Trial Comparative Study Multicenter Study]. Heart Rhythm. 2009;6(7):957–61.
Gunda S, Reddy M, Pillarisetti J, Atoui M, Badhwar N, Swarup V, et al. Differences in complication rates between large bore needle and a long micropuncture needle during epicardial access: time to change clinical practice? [Multicenter Study Observational Study]. Circ Arrhythmia Electrophysiol. 2015;8(4):890–5.
Aryana A, Saad EB, D’Avila A. Left atrial appendage occlusion and ligation devices: what is available, how to implement them, and how to manage and avoid complications. Curr Treat Options Cardiovasc Med. 2012;14(5):503–19.
Ramer SA, Sapp JL. Percutaneous intrapericardial injection of triamcinolone in a patient with incessant pericarditis: a novel technique. [Case Reports]. Can J Cardiol. 2013; 29(6): 751 e751-752. doi:10.1016/j.cjca.2012.09.003.
Haydin S, Saygi M, Ergul Y, Ozyilmaz I, Ozturk E, Akdeniz C, et al. Subxiphoid approach to epicardial implantation of implantable cardioverter defibrillators in children. [Clinical Trial]. Pacing Clin Electrophysiol. 2013;36(8):926–30.
Della Bella P, Brugada J, Zeppenfeld K, Merino J, Neuzil P, Maury P, et al. Epicardial ablation for ventricular tachycardia: a European multicenter study. [Multicenter Study]. Circ Arrhythm Electrophysiol. 2011;4(5):653–9.
Roberts-Thomson KC, Seiler J, Steven D, Inada K, Michaud GF, John RM, et al. Percutaneous access of the epicardial space for mapping ventricular and supraventricular arrhythmias in patients with and without prior cardiac surgery. [Research Support, Non-U.S. Gov’t]. J Cardiovasc Electrophysiol. 2010;21(4):406–11.
Bai R, Di Biase L, Shivkumar K, Mohanty P, Tung R, Santangeli P, et al. Ablation of ventricular arrhythmias in arrhythmogenic right ventricular dysplasia/cardiomyopathy: arrhythmia-free survival after endo-epicardial substrate based mapping and ablation. [Comparative Study Multicenter Study Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, Non-P.H.S.]. Circ Arrhythm Electrophysiol. 2011;4(4):478–85.
Dukkipati SR, D’Avila A, Soejima K, Bala R, Inada K, Singh S, et al. Long-term outcomes of combined epicardial and endocardial ablation of monomorphic ventricular tachycardia related to hypertrophic cardiomyopathy. [Multicenter Study Research Support, Non-U.S. Gov’t]. Circ Arrhythm Electrophysiol. 2011;4(2):185–94.
Izquierdo M, Sanchez-Gomez JM, Ferrero De Loma-Osorio A, Martinez A, Bellver A, Pelaez A, et al. Endo-epicardial versus only-endocardial ablation as a first line strategy for the treatment of ventricular tachycardia in patients with ischemic heart disease. Circ Arrhythm Electrophysiol. 2015;8(4):882–9.
Baman TS, Ilg KJ, Gupta SK, Good E, Chugh A, Jongnarangsin K, et al. Mapping and ablation of epicardial idiopathic ventricular arrhythmias from within the coronary venous system. [Research Support, Non-U.S. Gov’t]. Circ Arrhythm Electrophysiol. 2010;3(3):274–9.
Mountantonakis SE, Frankel DS, Tschabrunn CM, Hutchinson MD, Riley MP, Lin D, et al. Ventricular arrhythmias from the coronary venous system: prevalence, mapping, and ablation. [Research Support, Non-U.S. Gov’t]. Heart Rhythm. 2015;12(6):1145–53.
Avgil Tsadok M, Gagnon J, Joza J, Behlouli H, Verma A, Essebag V, et al. Temporal trends and sex differences in pulmonary vein isolation for patients with atrial fibrillation. [Research Support, Non-U.S. Gov’t]. Heart Rhythm. 2015;12(9):1979–86.
Bhave PD, Lu X, Girotra S, Kamel H, Vaughan Sarrazin MS. Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation. [Research Support, N.I.H., Extramural Research Support, U.S. Gov’t, Non-P.H.S. Research Support, U.S. Gov’t, P.H.S.]. Heart Rhythm. 2015;12(7):1406–12.
Gauri AJ, Davis A, Hong T, Burke MC, Knight BP. Disparities in the use of primary prevention and defibrillator therapy among blacks and women. [Research Support, Non-U.S. Gov’t]. Am J Med. 2006; 119(2):167 e117-121. doi:10.1016/j.amjmed.2005.08.021.
Roten L, Rimoldi SF, Schwick N, Sakata T, Heimgartner C, Fuhrer J, et al. Gender differences in patients referred for atrial fibrillation management to a tertiary center. Pacing Clin Electrophysiol. 2009;32(5):622–6.
Authors’ contributions
Concept/design was done by AMK and PAF. Data analysis/interpretation was performed by AMK and DOH. Drafting of the article was done by AMK. Critical revision of the article was done by AMK, AMS, SKM, CJM, PAN, SJA, and PAF. AMK, AMS, SKM, CJM, DOH, PAN, LF, TMM, DLP, SJA, and PAF approved the article. Statistics were from DOH. Funding was secured by the Mayo Clinic. Data collection was done by AMK and AMS.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Killu, A.M., Sugrue, A.M., Mulpuru, S.K. et al. Trends in percutaneous pericardial access during catheter ablation of ventricular arrhythmias: a single-center experience. J Interv Card Electrophysiol 47, 109–115 (2016). https://doi.org/10.1007/s10840-016-0132-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10840-016-0132-7