Percutaneous pericardial access for electrophysiological studies in patients with prior cardiac surgery: approach and understanding the risks

ABSTRACT

Introduction: The number of procedures for which percutaneous pericardial access is used for has gradually increased since its initial description, and now includes mapping/ablation, atrial appendage ligation and pericardial biopsy.

Areas covered: Successful percutaneous pericardial access is predicated on having a thorough understanding of regional anatomy, indications for attempting pericardial puncture and potential complications with appropriate management which are highlighted in this review. In addition, we will discuss the access technique itself, provide tips and pitfalls and highlight future directions with an emphasis on patients with prior cardiac surgery.

Expert commentary: Percutaneous epicardial access, especially in patients with prior cardiac surgery, is associated with significant complications and therefore meticulous preparation is required. Even in experienced centers, unusual circumstances may be crossed.

KEYWORDS:

• Ablation
• adhesions
• arrhythmia
• pericardium
• pericardiocentesis

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.