Catheter Ablation -> Ventricular Arrhythmias -> Ablation Techniques D-PO05 - Poster Session V (ID 39) Poster

D-PO05-184 - Avoiding Collateral Injury During Epicardial Access : A Novel Computed Tomography Guided Epicardial Puncture Technique (ID 1298)

 M. Subramanian: Nothing relevant to disclose.
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Background: Although current techniques of epicardial access are generally safe, puncture related major complications still occur in approximately 5% of patients.
Objective: This study assessed the feasibility and safety of a novel CT-guided epicardial access technique.
Methods: A pre-procedural CT was used to plan the course of epicardial access in 8 consecutive patients undergoing VT ablation. The approach, site, angle, depth of needle insertion, and damage to adjacent structures (right ventricle,diaphragm, liver,colon,internal mammary artery and its branches) was evaluated. A novel puncture technique guided by CT measurementswas used in all patients(Panel A). A post-procedural CT scan was superimposed in the same phase of respiration on the virtual planning image. Accuracy was measured by calculating the deviation of planned and executed epicardial access course in three dimensions(x,y,z) by an independent radiologist(Panel B-D).
Results: Epicardial access was obtained successfully in 100% of patients using anterior (n=2) and inferior (n=6) approaches. The deviation between planned and executed access with regards to angle(7.7 + 2.8 degrees), depth(6.7 + 2.0 mm), and site(x - 4.5 + 1.9 mm, y­ -5.4 + 2.1, z - 5.7 + 2.3) of needle insertion was low. In two patients, the epicardial needle had penetrated the diaphragm before entering the epicardial space. In the remaining six patients, there was no RV puncture, pericardial bleeding, or injury to sub-diaphragmatic vessels or viscera in any of the patient.
Conclusion: Along with precise CT-guided pre-procedural planning, this novel percutaneous technique appears to be a feasible and safe method for epicardial access.