Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.
J Cardiovasc Electrophysiol. 2021 Jul;32(7):1985-1994. doi: 10.1111/jce.15101. Epub 2021 May 20.
Percutaneous epicardial access (EA) was first described more than two decades ago. Since its initial introduction, indications for its utilization in the field of electrophysiology have expanded dramatically.
Epicardial mapping and ablation in patients with ventricular tachycardia is routinely performed in tertiary electrophysiology centers around the world. Although limited by lack of randomized controlled trials, epicardial ablation for atrial fibrillation has been suggested as a conjunctive strategy in patients who have failed an initial endocardial catheter ablation attempt, and it is necessary for placement of some left atrial appendage occlusion devices as well. An accurate understanding of the cardiac anatomy is crucial to avoid complications such as inadvertent right ventricular puncture, injury to the coronary arteries, abdominal viscera, phrenic nerves, and esophagus during both EA and catheter ablation.
The aim of this review is to provide a comprehensive overview of the cardiac anatomy, technical aspects to optimize the safety of epicardial puncture, recognize and avoid potential complications.
经皮心外膜入路（EA）早在二十多年前就有了描述。自最初引入以来，其在电生理学领域的应用指征已经大大扩展。
在世界各地的三级电生理中心，对室性心动过速患者进行心外膜标测和消融已成为常规操作。尽管缺乏随机对照试验的限制，但对于初始心内膜导管消融尝试失败的患者，心外膜消融已被建议作为一种联合策略，并且对于某些左心耳封堵装置的放置也是必要的。准确了解心脏解剖结构对于避免并发症至关重要，例如在 EA 和导管消融过程中无意的右心室穿刺、冠状动脉、腹部脏器、膈神经和食管损伤。
本综述的目的是全面概述心脏解剖结构、优化心外膜穿刺安全性的技术方面、识别和避免潜在并发症。
