Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Heart Rhythm. 2013 Nov;10(11):1613-21. doi: 10.1016/j.hrthm.2013.08.019. Epub 2013 Aug 22.
With the increasing use, complexity, anatomical approaches, and tools related to epicardial procedures, complications previously not seen during endovascular ablation are now well recognized with epicardial ablation. Whether newer approaches and the regional anatomy of the pericardial space contribute to unexpected complications after epicardial access (EpiAcc) is presently unknown.
To characterize underreported, or novel, complications associated with percutaneous EpiAcc as part of an electrophysiology procedure.
We retrospectively reviewed percutaneous EpiAcc as part of an ablation procedure from January 1, 2004, to December 31, 2011.
Of 116 attempts in 107 patients, 8 atypical ablation complications (no procedural deaths) were noted; complications included delayed pericarditis (2 weeks), chronic refractory pericarditis, requirement for snaring of broken intrapericardial wire, pleural perforation, phrenic nerve injury despite protective strategies, hemoperitoneum, and abdominal-pericardial fistula.
Vigilance both during and after EpiAcc is needed to recognize these complications, some of which may be life-threatening.
随着心外膜手术中所用器械的增多、技术的日趋复杂、解剖方法的改进，心外膜手术相关并发症逐渐增多，其中一些并发症在经导管消融术中并不常见。目前尚不清楚新的入路方法和心包区域解剖是否会导致心外膜入路（EpiAcc）后出现意外并发症。
本研究旨在分析经皮 EpiAcc 作为心脏电生理消融术一部分时发生的少见或新发并发症。
回顾性分析 2004 年 1 月 1 日至 2011 年 12 月 31 日接受经皮 EpiAcc 的患者，评估这些患者的并发症。
107 例患者共进行了 116 次 EpiAcc，8 例（无手术死亡）出现了非典型消融并发症，包括心包炎延迟发作（2 周）、慢性难治性心包炎、心包内断针需要套扎、胸腔穿孔、尽管采取了保护策略仍出现膈神经损伤、腹腔积血和腹部-心包瘘。
EpiAcc 过程中和之后都需要保持警惕，以便识别这些并发症，其中一些并发症可能会危及生命。
