Background: Establishing pericardial access in the electrophysiology (EP) lab is a necessary step in epicardial ventricular tachycardia ablation and can be lifesaving when ablation or device implant procedures are complicated by cardiac perforation and cardiac tamponade. Pericardiocentesis is associated with multiple potential complications including but not limited to hepatic injury, pneumothorax, cardiac perforation and death. As such, pericardiocentesis is a skill that EP fellows must master during training, however, opportunities to perform this procedure are typically rare.
Objective: We hypothesized that a cadaveric pericardiocentesis model could be used to create a high fidelity, low risk simulation experience for EP trainees.
Methods: A pericardiocentesis model was constructed using a cadaver prepared with a soft-preservation technique. A window was created in the left anterior chest. After retracting the lung, the parietal pericardium was isolated with forceps. A small gauge needle was inserted into the pericardial space. The pericardium was then filled with colored saline.
Results: Using a subxiphoid approach, while maintaining the needle at a 45 degree angle and while aiming for the left shoulder, successful pericardial access was obtained. (Figure 1) Repeated punctures were possible with this model allowing for high fidelity simulation for multiple learners.
Conclusion: In this proof of concept model, we created a high fidelity, low risk cadaveric pericardiocentesis simulation experience. This model provides a valuable, necessary and potentially lifesaving learning opportunity for EP trainees.