Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Cardiology Department, Rouen University Hospital, Rouen, France.
Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
JACC Clin Electrophysiol. 2024 Jul;10(7 Pt 2):1565-1573. doi: 10.1016/j.jacep.2024.05.004. Epub 2024 May 16.
Epicardial (Epi) access is commonly required during ventricular tachycardia ablation. Conventional Epi (ConvEpi) access targets a "dry" pericardial space presenting technical challenges and risk of complications. Recently, intentional puncture of coronary venous branches with Epi carbon dioxide insufflation (EpiCO) has been described as a technique to improve Epi access. The safety of this technique relative to conventional methods remains unproven.
The authors sought to compare the feasibility and safety of EpiCO to ConvEpi access.
All patients at a high-volume center undergoing Epi access between January 2021 and December 2023 were included and grouped according to ConvEpi or EpiCO approach. Access technique was according to the discretion of the operator.
Epi access was attempted in 153 cases by 17 different operators (80 ConvEpi vs 73 EpiCO). There was no difference in success rate whether the ConvEpi or EpiCO approach was used (76 [95%] cases vs 67 [91.8%] cases; P = 0.4). Total Epi access time was shorter in the ConvEpi group compared with the EpiCO group (16.3 ± 11.6 minutes vs 26.9 ± 12.7 minutes; P < 0.001), though the total procedure duration was similar. Major Epi access-related complications occurred in only the ConvEpi group (6 [7.5%] ConvEpi vs 0 [0%] EpiCo; P = 0.02). Bleeding ≥80 mL was more frequently observed following ConvEpi access (14 [17.5%] cases vs 4 [5.5%] cases; P = 0.02). After adjusting for age, repeat Epi access, and antithrombotic therapy, EpiCO was associated with a reduction in bleeding ≥80 mL (OR: 0.27; 95% CI: 0.08-0.89; P = 0.03).
EpiCO access is associated with lower rates of major complication and bleeding when compared with ConvEpi access.
心外膜（Epi）入路在室性心动过速消融中通常是必需的。传统的 Epi（ConvEpi）入路针对的是“干燥”的心包腔，这带来了技术挑战和并发症风险。最近，用 Epi 二氧化碳注入（EpiCO）故意穿刺冠状静脉分支的技术已被描述为改善 Epi 入路的一种方法。与传统方法相比，这种技术的安全性仍未得到证实。
作者旨在比较 EpiCO 与 ConvEpi 入路的可行性和安全性。
所有于 2021 年 1 月至 2023 年 12 月在一家高容量中心接受 Epi 入路的患者均被纳入研究，并根据 ConvEpi 或 EpiCO 方法进行分组。入路技术由术者自行决定。
17 名不同的术者尝试了 153 例 Epi 入路（80 例 ConvEpi 与 73 例 EpiCO）。使用 ConvEpi 或 EpiCO 方法的成功率无差异（76[95%]例与 67[91.8%]例；P=0.4）。与 EpiCO 组相比，ConvEpi 组的总 Epi 入路时间更短（16.3±11.6 分钟与 26.9±12.7 分钟；P<0.001），但总手术时间相似。仅在 ConvEpi 组发生了主要与 Epi 入路相关的并发症（6[7.5%]例 ConvEpi 与 0[0%]例 EpiCo；P=0.02）。与 ConvEpi 入路相比，EpiCO 后更常观察到≥80 毫升的出血（14[17.5%]例与 4[5.5%]例；P=0.02）。在调整年龄、重复 Epi 入路和抗血栓治疗后，EpiCO 与≥80 毫升的出血减少相关（OR：0.27；95%CI：0.08-0.89；P=0.03）。
与 ConvEpi 入路相比，EpiCO 入路与较低的主要并发症和出血发生率相关。
