Abstract 18318: Percutaneous Epicardial Access for Mapping and Ablation is Feasible in Patients With Prior Cardiac Surgery, Including Coronary Bypass Surgery
Introduction: Prior cardiac surgery, especially the presence of coronary bypass grafts, is thought to preclude percutaneous epicardial access (EpiAcc) and, due to limited catheter maneuverability, mapping and ablation. The objective of our study was to evaluate the feasibility and safety of EpiAcc in patients with prior cardiac surgery.
Methods: We retrospectively analyzed all patients who underwent EpiAcc as part of an ablation procedure between 01/01/2004-06/30/2013 at Mayo Clinic, Rochester, MN. All had documented VT or recurring, symptomatic PVCs. Baseline clinical characteristics and procedural characteristics were collected.
Results: Of 162 patients that underwent EpiAcc, 18 had prior cardiac surgery (mean age 61 years, all male). This included 10 CABG, 2 epicardial ICD placement, 5 valve surgery (3 aortic valve, 2 mitral valve), 2 septal myectomy, 1 aortic arch replacement, 1 myocardial bridge unroofing and 1 myocardial perforation repair (3 patients had multiple procedures). Access was successful in 12 patients (66.7%); the inferior approach was utilized in 78%. Of patients with prior CABG, successful access was attained in 6 (60%). The average procedural time was 441.6 ± 141.3 minutes. Adhesiolysis was required in 10 patients with the sheath, access wire, pigtail catheter or ablation catheter. Intra-procedural coronary angiography was performed in 8 patients. There were a total of 45 VTs/PVCs ablated in 18 patients (average 2.5 ± 1.7), mean cycle length 463.6 ± 95.9ms. Ultimately, 12 patients (66.7%) underwent endocardial only ablation, 1 (5.5%) had epicardial only ablation while 5 (27.8%) had endocardial/epicardial ablation. The procedure was deemed successful in 13 patients (72.2%). Four patients had bleeding complications (pericardial effusion, pericardial hematoma, hemoperitoneum and pericardial tamponade [the latter required repair of the RV wall]). In patients with coronary grafts, there was no evidence of acute graft disruption.
Conclusions: Percutaneous epicardial access is feasible in patients with previous cardiac surgery, including CABG. However, adhesiolysis is frequently required. Although the risk of coronary graft injury is low, life-threatening complications may occur.
Author Disclosures: A.M. Killu: None. E. Ebrille: None. S.J. Asirvatham: Consultant/Advisory Board; Modest; Abiomed, Atricure, Biotronik, Biosense Webster, Boston Scientific, Medtronic, Spectranetics, St. Jude, Sanofi-Aventis, Wolters Kluwer, Elsevier. Other; Modest; Aegis, ATP, Nevro, Sanovas, Sorin Medical. T.M. Munger: None. C.J. McLeod: None. D.L. Packer: Research Grant; Modest; Endosense, Siemens Acuson, EP Advocate, U of Minnesota Partnership for Biotechnology and Medical Genomics, CardioFocus, Hansen Medical, Thermedical. Consultant/Advisory Board; Modest; Abiomed $0, Biosense Webster $0, Boston Scientific $0, CardioDX $0, CardioFocus $0, CardioInsight $0, InfoBionics $0, Johnson & Johnson $0, Medtronic/CryoCath $0, Sanofi-Aventis $0, Siemens $0, St. Jude Medical $0, OrthoMcNeill $0. Other; Modest; Royalty Blackwell Publishing, Oxford Publishing, Oxford Royalty. Research Grant; Significant; Biosense Webster, EpiEP, Medtronic, NIH, AHA Fellow Grant, Boston Scientific, St. Jude Medical. Other; Significant; Royalty St. Jude Medical. P.A. Friedman: Research Grant; Modest; Medtronik, Biotronik. Consultant/Advisory Board; Modest; Bard, Biotronik, Leadex, Sorin, Boston Scientific, Helical Solutions. Other; Modest; Bard EP, Medical Positioning Inc, Aegis Medical, NeoChord, Preventice, Sorin. S.K. Mulpuru: None.
- © 2014 by American Heart Association, Inc.