SPC365

Novel Epicardial Access Technique Facilitated by Carbon Dioxide Insufflation of the Pericardium for Ablation of Arrhythmias

Session: Comunicações Orais - Sessão 13 - Taquicardia Ventricular e Morte Súbita Cardíaca
Speaker: Bruno Tereno Valente

Congress: CPC 2023
Topic: C. Arrhythmias and Device Therapy
Theme: 08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme: 08.7 Ventricular Arrhythmias and SCD - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: Bruno Tereno Valente; Pedro Cunha; Guilherme Portugal; Ana Lousinha; Paulo Osório; Andre Viveiros Monteiro; Mário Oliveira

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:13.5pt"><span style="font-family:&quot;Georgia&quot;,serif"><span style="color:#505050">Introduction</span></span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:13.5pt"><span style="font-family:&quot;Georgia&quot;,serif"><span style="color:#2e2e2e">Epicardial access for mapping and ablation of the epicardial substrate may be required in catheter ablation of arrythmias. High complication rates are associated with the standard epicardial access approach. Recently, a novel method of intentional coronary vein (CV) exit with pericardial CO</span></span></span><sub><span style="font-size:10.0pt"><span style="font-family:&quot;Georgia&quot;,serif"><span style="color:#2e2e2e">2</span></span></span></sub><span style="font-size:13.5pt"><span style="font-family:&quot;Georgia&quot;,serif"><span style="color:#2e2e2e">&nbsp;insufflation to facilitate epicardial access has been described. This study describes our initial experience with this technique.</span></span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:13.5pt"><span style="font-family:&quot;Georgia&quot;,serif"><span style="color:#505050">Methods</span></span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:13.5pt"><span style="font-family:&quot;Georgia&quot;,serif"><span style="color:#2e2e2e">Patients undergoing consecutive epicardial ablation between &nbsp;September 2021 and June 2022 at our hospital were included in this study. Via femoral venous access, a branch of the coronary sinus was sub-selected and intentional CV exit was performed with a high tip load coronary angioplasty wire. A microcatheter was then advanced over the wire into the pericardial space, followed by pericardial CO</span></span></span><sub><span style="font-size:10.0pt"><span style="font-family:&quot;Georgia&quot;,serif"><span style="color:#2e2e2e">2</span></span></span></sub><span style="font-size:13.5pt"><span style="font-family:&quot;Georgia&quot;,serif"><span style="color:#2e2e2e">&nbsp;insufflation, facilitating subxiphoid pericardial puncture. In one patient access was performed from right atrial appendage because congenital anomalous return of the coronary sinus to left atrium.</span></span></span></span></span></p>

<p>&nbsp;</p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:13.5pt"><span style="font-family:&quot;Georgia&quot;,serif"><span style="color:#505050">Results</span></span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:13.5pt"><span style="font-family:&quot;Georgia&quot;,serif"><span style="color:#2e2e2e">Nine patients underwent epicardial access attempt for arrythmia mapping and ablation. All patients had successful intentional CV exit and CO</span></span></span><sub><span style="font-size:10.0pt"><span style="font-family:&quot;Georgia&quot;,serif"><span style="color:#2e2e2e">2</span></span></span></sub><span style="font-size:13.5pt"><span style="font-family:&quot;Georgia&quot;,serif"><span style="color:#2e2e2e">&nbsp;facilitated epicardial access except one patient because of adhesions from previous heart surgery. The type of ablations performed were 6 ventricular tachycardia, one epicardial accessory pathway ablation and one left epicardial flutter ablation. All the patients had previous endocardial unsuccessful ablations.</span></span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:13.5pt"><span style="font-family:&quot;Georgia&quot;,serif"><span style="color:#505050">Conclusion</span></span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:13.5pt"><span style="font-family:&quot;Georgia&quot;,serif"><span style="color:#2e2e2e">This is the first case series of epicardial access facilitated by CO</span></span></span><sub><span style="font-size:10.0pt"><span style="font-family:&quot;Georgia&quot;,serif"><span style="color:#2e2e2e">2</span></span></span></sub><span style="font-size:13.5pt"><span style="font-family:&quot;Georgia&quot;,serif"><span style="color:#2e2e2e">&nbsp;insufflation in Portugal. This technique enabled successful epicardial access in all patients except one patient due to strong epicardial adhesions, there was no adverse outcomes from epicardial access. The extreme safety of this approach allowed to perform epicardial ablations not only of ventricular arrhythmias but also of atrial arrythmias successfully, an additional potential to explore in the field of epicardial ablations.</span></span></span></span></span></p>