Differences in Complication Rates between Large Bore Needle and a Long Micropuncture Needle during Epicardial Access

Sampath Gunda, Madhu Reddy, Jayasree Pillarisetti, Moustapha Atoui, Nitish Badhwar, Vijay Swarup, Luigi Dibiase, Sanghamitra Mohanty, Prashanth Mohanty, Hosakote Nagaraj, Christopher Ellis, Abdi Rasekh, Jie Cheng, Krzysztof Bartus, Randall Lee, Andrea Natale, Dhanunjaya Lakkireddy

Research output: Contribution to journalArticlepeer-review

69 Scopus citations


Background - A dry epicardial access (EA) is increasingly used for advanced cardiovascular procedures. Conventionally used large bore needles (Tuohy or Pajunk needle; LBN) have been associated with low but definite incidence of major complications with EA. Use of micropuncture needle (MPN) may decrease the risk of complications. We intended to compare the outcomes of LBN with MPN for EA. Methods and Results - We report a multicenter observational study of consecutive patients who underwent EA for ventricular tachycardia ablation or Lariat procedure using the LBN or MPN. Oral anticoagulation was stopped before the procedure. Baseline characteristics and procedure-related complications were collected and compared. Of the 404 patients, LBN and MPN were used in 46% and 54% of patients, respectively. There was no significant difference in the incidence of inadvertent puncture of myocardium between LBN and MPN (7.6% versus 6.8%, P=0.76). However, there was a significantly higher rate of large pericardial effusions with LBN compared with MPN (8.1% versus 0.9%; P<0.001). The incidence of pleural effusions were not significantly different between both (1.6% versus 2.3%; P=0.64). LBN group had an increase in other complications compared with MPN (open heart surgery to repair cardiac laceration [6 versus 0], injury to liver [1 versus 0], coronaries [1 versus 0], and superior epigastric artery requiring surgical exploration [0 versus 1]). Conclusions - The use of MPN is associated with decreased incidence of major complications, and the need for surgical repair and routine use should be considered for EA.

Original languageEnglish (US)
Pages (from-to)890-895
Number of pages6
JournalCirculation: Arrhythmia and Electrophysiology
Issue number4
StatePublished - Aug 22 2015


  • electrophysiology
  • needles
  • pericardial effusion
  • punctures
  • tachycardia
  • ventricular

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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