Abstract 17703: Obesity Does Not Increase Complication Rates of Percutaneous Epicardial Access

Abstract

Introduction: Percutaneous epicardial access (EA) increases options for ablative therapies as well as novel techniques such as atrial appendage closure. Whilst elevated body mass index (BMI) has been associated with a higher complication rate in other procedures, this relationship is unknown in patients undergoing EA. We hypothesize that due to the steeper entry angle or lower puncture site required and the hazards associated with this, overweight individuals are at increased risk of complications. Methods & results: We retrospectively reviewed all patients undergoing EA in a single center from 2004-2012. One hundred and twelve patients (average age 51.7 years, 65% male) were identified and classified into quartiles according to BMI (n=28 in each quartile, average BMI 22.1, 26.5, 30.2 and 37.2 in groups 1-4, respectively; P=<.0001). At baseline, there was no difference in gender, EF, creatinine, hemoglobin, and history of cardiac surgery or prior pericardial access between groups. Furthermore, there was no difference in the type of epicardial approach (anterior versus inferior) used. While those in quartile 1 tended to be younger (mean age 44.3 vs. 53.8, 54.5 and 55.4 years; P=.007) with less hypertension (32.1 vs. 64.3, 60.7 and 71.4% in quartiles 2, 3 and 4, respectively; P=.017), quartile 4 had higher rates of diabetes (64.7 vs. 0, 17.7 and 17.7% in quartile 1, 2 and 3, respectively; P=.0003). There was no difference in the overall (major and minor) complication rate between groups. Specifically, quartile 4 had a comparable complication rate to the other quartiles (26.7 vs. 26.7, 30 and 16.7% in groups 1, 2 and 3; P= .65). Likewise, there was no difference in the pericardial (P=.61) and extra-pericardial (P=.32) complications rate, including abdominal complications between groups.

Conclusion: Percutaneous epicardial access and ablation can be performed without added risk of complications in obese individuals.