Mastering the art of epicardial access in cardiac electrophysiology

Jorge Romero, Kalayanam Shivkumar, Luigi Di Biase, Ricardo Avendano, Robert D. Anderson, Andrea Natale, Saurabh Kumar

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Access to the epicardial space is fundamental to several cardiac procedures. While traditional indications include catheter ablation of ventricular arrhythmias and accessory pathways, novel indications include left atrial appendage occlusion, esophageal protection, mapping and ablation during atrial fibrillation procedures, implantation of epicardial pacing leads, and phrenic nerve displacement to facilitate safe ablation of atrial and ventricular arrhythmias. Accessing the epicardial space safely is a major challenge requiring intimate knowledge of cardiac anatomy, extensive training, and expertise. Over the past years, multiple technological advances have led to significant improvements in epicardial access success and safety. Important examples of such advances include CO2 insufflation through the coronary sinus or the right atrial appendage, pressure sensor needle, computed tomography, cardiac magnetic resonance, and electroanatomic mapping–guided epicardial access. In addition, we provide special maneuvers to minimize inadvertent right ventricular perforation.

Original languageEnglish (US)
Pages (from-to)1738-1749
Number of pages12
JournalHeart Rhythm
Volume16
Issue number11
DOIs
StatePublished - Nov 2019
Externally publishedYes

Fingerprint

Cardiac Electrophysiology
Atrial Appendage
Art
Cardiac Arrhythmias
Insufflation
Phrenic Nerve
Atrial Pressure
Catheter Ablation
Coronary Sinus
Atrial Fibrillation
Needles
Anatomy
Magnetic Resonance Spectroscopy
Tomography
Safety

Keywords

  • Arrhythmias
  • Epicardial ablation
  • Epicardial access
  • Phrenic nerve protection
  • Right ventricular perforation
  • Techniques

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Romero, J., Shivkumar, K., Di Biase, L., Avendano, R., Anderson, R. D., Natale, A., & Kumar, S. (2019). Mastering the art of epicardial access in cardiac electrophysiology. Heart Rhythm, 16(11), 1738-1749. https://doi.org/10.1016/j.hrthm.2019.04.038

Mastering the art of epicardial access in cardiac electrophysiology. / Romero, Jorge; Shivkumar, Kalayanam; Di Biase, Luigi; Avendano, Ricardo; Anderson, Robert D.; Natale, Andrea; Kumar, Saurabh.

In: Heart Rhythm, Vol. 16, No. 11, 11.2019, p. 1738-1749.

Research output: Contribution to journalArticle

Romero, J, Shivkumar, K, Di Biase, L, Avendano, R, Anderson, RD, Natale, A & Kumar, S 2019, 'Mastering the art of epicardial access in cardiac electrophysiology', Heart Rhythm, vol. 16, no. 11, pp. 1738-1749. https://doi.org/10.1016/j.hrthm.2019.04.038
Romero, Jorge ; Shivkumar, Kalayanam ; Di Biase, Luigi ; Avendano, Ricardo ; Anderson, Robert D. ; Natale, Andrea ; Kumar, Saurabh. / Mastering the art of epicardial access in cardiac electrophysiology. In: Heart Rhythm. 2019 ; Vol. 16, No. 11. pp. 1738-1749.
@article{d36af0fa3dba4ecfbf120aaa59ea571b,
title = "Mastering the art of epicardial access in cardiac electrophysiology",
abstract = "Access to the epicardial space is fundamental to several cardiac procedures. While traditional indications include catheter ablation of ventricular arrhythmias and accessory pathways, novel indications include left atrial appendage occlusion, esophageal protection, mapping and ablation during atrial fibrillation procedures, implantation of epicardial pacing leads, and phrenic nerve displacement to facilitate safe ablation of atrial and ventricular arrhythmias. Accessing the epicardial space safely is a major challenge requiring intimate knowledge of cardiac anatomy, extensive training, and expertise. Over the past years, multiple technological advances have led to significant improvements in epicardial access success and safety. Important examples of such advances include CO2 insufflation through the coronary sinus or the right atrial appendage, pressure sensor needle, computed tomography, cardiac magnetic resonance, and electroanatomic mapping–guided epicardial access. In addition, we provide special maneuvers to minimize inadvertent right ventricular perforation.",
keywords = "Arrhythmias, Epicardial ablation, Epicardial access, Phrenic nerve protection, Right ventricular perforation, Techniques",
author = "Jorge Romero and Kalayanam Shivkumar and {Di Biase}, Luigi and Ricardo Avendano and Anderson, {Robert D.} and Andrea Natale and Saurabh Kumar",
year = "2019",
month = "11",
doi = "10.1016/j.hrthm.2019.04.038",
language = "English (US)",
volume = "16",
pages = "1738--1749",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",
number = "11",

}

TY - JOUR

T1 - Mastering the art of epicardial access in cardiac electrophysiology

AU - Romero, Jorge

AU - Shivkumar, Kalayanam

AU - Di Biase, Luigi

AU - Avendano, Ricardo

AU - Anderson, Robert D.

AU - Natale, Andrea

AU - Kumar, Saurabh

PY - 2019/11

Y1 - 2019/11

N2 - Access to the epicardial space is fundamental to several cardiac procedures. While traditional indications include catheter ablation of ventricular arrhythmias and accessory pathways, novel indications include left atrial appendage occlusion, esophageal protection, mapping and ablation during atrial fibrillation procedures, implantation of epicardial pacing leads, and phrenic nerve displacement to facilitate safe ablation of atrial and ventricular arrhythmias. Accessing the epicardial space safely is a major challenge requiring intimate knowledge of cardiac anatomy, extensive training, and expertise. Over the past years, multiple technological advances have led to significant improvements in epicardial access success and safety. Important examples of such advances include CO2 insufflation through the coronary sinus or the right atrial appendage, pressure sensor needle, computed tomography, cardiac magnetic resonance, and electroanatomic mapping–guided epicardial access. In addition, we provide special maneuvers to minimize inadvertent right ventricular perforation.

AB - Access to the epicardial space is fundamental to several cardiac procedures. While traditional indications include catheter ablation of ventricular arrhythmias and accessory pathways, novel indications include left atrial appendage occlusion, esophageal protection, mapping and ablation during atrial fibrillation procedures, implantation of epicardial pacing leads, and phrenic nerve displacement to facilitate safe ablation of atrial and ventricular arrhythmias. Accessing the epicardial space safely is a major challenge requiring intimate knowledge of cardiac anatomy, extensive training, and expertise. Over the past years, multiple technological advances have led to significant improvements in epicardial access success and safety. Important examples of such advances include CO2 insufflation through the coronary sinus or the right atrial appendage, pressure sensor needle, computed tomography, cardiac magnetic resonance, and electroanatomic mapping–guided epicardial access. In addition, we provide special maneuvers to minimize inadvertent right ventricular perforation.

KW - Arrhythmias

KW - Epicardial ablation

KW - Epicardial access

KW - Phrenic nerve protection

KW - Right ventricular perforation

KW - Techniques

UR - http://www.scopus.com/inward/record.url?scp=85071764489&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071764489&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2019.04.038

DO - 10.1016/j.hrthm.2019.04.038

M3 - Article

C2 - 31015022

AN - SCOPUS:85071764489

VL - 16

SP - 1738

EP - 1749

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 11

ER -