Abstract 17732: Does the Inferior Technique and Prior Pericardial Procedures Increase the Risk of Complications with Epicardial Ablation?
Introduction: Complications related to percutaneous epicardial access involve trauma to subdiaphragmatic structures, the pleural space, and inadvertent myocardial puncture and subsequent sequelae. It is unclear whether inferior approach (INF) to the pericardial space (thought to be associated with subdiaphragmatic puncture) and prior pericardial procedures (surgery, ablation) increase the likelihood of untoward events.
Methods & Results: Of 121 patients undergoing planned percutaneous epicardial access as part of an ablation procedure from 1/2004 - 12/2011, 112 were successful (92.6%). Of these, 73 (65%) were male with a median age of 53 years. INF access was performed in 70 patients. There was no difference in age, gender, BMI, EF, diabetes, hemoglobin, creatinine, prior cardiac surgery or pericardial access between anterior (ANT) and INF groups. Complications, classified as pericardial (pericardial effusion, tamponade, coronary vessel damage) and extrapericardial (pleural injury, abdominal injury/ bleeding) were compared between the two groups. The INF group had 20 pericardial complications while the ANT group had 5 (P=.095); of extrapericardial complications, the INF group had 5 while the ANT group had 1 (P=.42). The overall (major and minor) complication rate tended to be higher with INF access (32.9 vs 15.4%, P=.07); 15 (48%) of those with any complication required blood transfusion (n=14) and/or invasive procedure (n=2) during the index hospitalization. Analysis of successful attempts in those with prior cardiac surgery or pericardial ablation (n=19) did not reveal a higher complication rate compared to those without (31.6 vs 25.8%, P=.58). There were no procedural related deaths.
Conclusion: There is a trend towards a higher complication rate with the inferior approach to epicardial access. However, when pericardial access is successful, prior cardiac surgery or previous pericardial access does not increase the likelihood of complications.
- © 2012 by American Heart Association, Inc.