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 Di Biase, Sanghamitra Mohanty, Prashanth Mohanty, Hosakote Nagaraj, Christopher Ellis, Abdi Rasekh, Jie Cheng, Krzysztof Bartus, Randall Lee, Andrea Natale, Dhanunjaya Lakkireddy

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

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
Volume8
Issue number4
DOIs
StatePublished - Aug 22 2015

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Punctures
Needles
Incidence
Epigastric Arteries
Pericardial Effusion
Lacerations
Pleural Effusion
Ventricular Tachycardia
Thoracic Surgery
Multicenter Studies
Observational Studies
Myocardium
Liver
Wounds and Injuries

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Differences in Complication Rates between Large Bore Needle and a Long Micropuncture Needle during Epicardial Access. / Gunda, Sampath; Reddy, Madhu; Pillarisetti, Jayasree; Atoui, Moustapha; Badhwar, Nitish; Swarup, Vijay; Di Biase, Luigi; Mohanty, Sanghamitra; Mohanty, Prashanth; Nagaraj, Hosakote; Ellis, Christopher; Rasekh, Abdi; Cheng, Jie; Bartus, Krzysztof; Lee, Randall; Natale, Andrea; Lakkireddy, Dhanunjaya.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 8, No. 4, 22.08.2015, p. 890-895.

Research output: Contribution to journalArticle

Gunda, S, Reddy, M, Pillarisetti, J, Atoui, M, Badhwar, N, Swarup, V, Di Biase, L, Mohanty, S, Mohanty, P, Nagaraj, H, Ellis, C, Rasekh, A, Cheng, J, Bartus, K, Lee, R, Natale, A & Lakkireddy, D 2015, 'Differences in Complication Rates between Large Bore Needle and a Long Micropuncture Needle during Epicardial Access', Circulation: Arrhythmia and Electrophysiology, vol. 8, no. 4, pp. 890-895. https://doi.org/10.1161/CIRCEP.115.002921
Gunda, Sampath ; Reddy, Madhu ; Pillarisetti, Jayasree ; Atoui, Moustapha ; Badhwar, Nitish ; Swarup, Vijay ; Di Biase, Luigi ; Mohanty, Sanghamitra ; Mohanty, Prashanth ; Nagaraj, Hosakote ; Ellis, Christopher ; Rasekh, Abdi ; Cheng, Jie ; Bartus, Krzysztof ; Lee, Randall ; Natale, Andrea ; Lakkireddy, Dhanunjaya. / Differences in Complication Rates between Large Bore Needle and a Long Micropuncture Needle during Epicardial Access. In: Circulation: Arrhythmia and Electrophysiology. 2015 ; Vol. 8, No. 4. pp. 890-895.
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abstract = "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.",
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AU - Gunda, Sampath

AU - Reddy, Madhu

AU - Pillarisetti, Jayasree

AU - Atoui, Moustapha

AU - Badhwar, Nitish

AU - Swarup, Vijay

AU - Di Biase, Luigi

AU - Mohanty, Sanghamitra

AU - Mohanty, Prashanth

AU - Nagaraj, Hosakote

AU - Ellis, Christopher

AU - Rasekh, Abdi

AU - Cheng, Jie

AU - Bartus, Krzysztof

AU - Lee, Randall

AU - Natale, Andrea

AU - Lakkireddy, Dhanunjaya

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N2 - 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.

AB - 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.

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