| Percutaneous transatrial access to the pericardial space for epicardial mapping and ablation. | |
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MedLine Citation:
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PMID: 21430128 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Puncture of the atrial appendage may provide access to the pericardial space. The aim of this study was to evaluate the feasibility of epicardial mapping and ablation through an endocardial transatrial access in a swine model. METHODS AND RESULTS: An 8-F Mullins sheath was used to perforate the right (n=16) or left (n=1) atrial appendage in 17 pigs (median weight, 27.5 kg; first and third quartiles [Q1, Q3], 25.2, 30.0 kg). A 7-F ablation catheter was introduced into the pericardial space to perform epicardial mapping and deliver radiofrequency pulses on the atria. The pericardial space was entered in all 17 animals. In 15 (88%) animals, there was no hemodynamic instability (mean blood pressure monitoring, initial median, 80 mm Hg; Q1, Q3, 70, 86 mm Hg; final median, 88 mm Hg; Q1, Q3, 80, 96 mm Hg; P=0.426). In these 15, a mild hemorrhagic pericardial effusion was identified and aspirated (median, 20 mL; Q1, Q3, 15, 30 mL) during the procedure, and postmortem gross analysis revealed that the atrial perforation was closed in these animals. In 2 (12%) of the 17 animals, there was major pericardial bleeding with hemodynamic collapse. On gross examination, it was found that pericardial space was accessed through right ventricular perforation in 1 animal and the tricuspid annulus in the other. After the initial study, we used an occlusion device in 3 other animals to attempt to seal the puncture (2 at the right atrial appendage and 1 at the right ventricle). These 3 animals had no significant pericardial bleeding. CONCLUSIONS: Transatrial endovascular right atrial appendage puncture may provide a potential alternative route for pericardial access. Further studies are needed to evaluate its safety with longer and more-complex procedures before being applied in clinical settings. |
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Authors:
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Mauricio I Scanavacca; Ana Claudia Venancio; Cristiano F Pisani; Sissy Lara; Denise Hachul; Francisco Darrieux; Carina Hardy; Edna Paola; Vera D Aiello; Srijoy Mahapatra; Eduardo Sosa |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't Date: 2011-03-23 |
Journal Detail:
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Title: Circulation. Arrhythmia and electrophysiology Volume: 4 ISSN: 1941-3084 ISO Abbreviation: Circ Arrhythm Electrophysiol Publication Date: 2011 Jun |
Date Detail:
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Created Date: 2011-06-15 Completed Date: 2011-09-01 Revised Date: 2012-02-03 |
Medline Journal Info:
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Nlm Unique ID: 101474365 Medline TA: Circ Arrhythm Electrophysiol Country: United States |
Other Details:
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Languages: eng Pagination: 331-6 Citation Subset: IM |
Affiliation:
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Arrhythmia Clinical Unit of Heart Institute, University of São Paulo Medical School, Brazil. mauricio.scanavacca@gmail.com |
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| MeSH Terms | |
Descriptor/Qualifier:
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Animals Atrial Fibrillation / physiopathology, surgery* Catheter Ablation / methods* Disease Models, Animal Epicardial Mapping / methods* Feasibility Studies Heart Atria / physiopathology, surgery* Heart Catheterization / methods* Pericardium / physiopathology, surgery* Swine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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