Ditac Geoffroy, Verhaeghe Laurens, Pambrun Thomas, Benali Karim, Johner Nicolas, Kneizeh Kinan, Plant Allan, Fitzgerald John L, Vlachos Konstantinos, Sacristan Benjamin, Charton Jan, Arnaud Marine, Bouyer Benjamin, Tixier Romain, Derval Nicolas, Hocini Mélèze, Haïssaguerre Michel, Jaïs Pierre, Sacher Frédéric, Duchateau Josselin
Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Leveque, Bordeaux University Hospital, Bordeaux, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, Bordeaux, France; Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France.
Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Leveque, Bordeaux University Hospital, Bordeaux, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, Bordeaux, France.
Heart Rhythm. 2025 Jul;22(7):1718-1727. doi: 10.1016/j.hrthm.2025.03.1967. Epub 2025 Mar 20.
Epicardial access (EA) is an essential tool for ablation of certain arrhythmias, but conventional techniques carry inherent risks. Carbon dioxide (CO) insufflation in the pericardium through the coronary sinus aims to facilitate EA but is time-consuming and not widely used. Transatrial pericardial insufflation of CO (TAPI-CO) offers a simplified alternative, underexplored in electrophysiology procedures.
This study aimed to evaluate the efficacy and safety of TAPI-CO for EA in electrophysiology procedures.
This retrospective study included all patients undergoing EA with TAPI-CO at a tertiary care center between December 2020 and November 2024. The procedure involved intentional right atrial appendage perforation for CO insufflation, followed by subxiphoid puncture for EA. Success rates, procedural characteristics, and complications were assessed.
Fifteen patients (6 with atrial arrhythmias and 9 with ventricular arrhythmias) were included. TAPI-CO was successfully performed in 14 patients (93.3%), and subxiphoid EA was achieved in 13 (86.7%). There were major adhesions in 2 patients (13.3%). No significant bleeding was observed after right atrial appendage perforation. One patient (6.7%) had delayed pericardial effusion related to TAPI-CO. No patient required surgery. Median procedural duration was 265 minutes (interquartile range, 190-288 minutes), and fluoroscopy time was 28 minutes (interquartile range, 24-32 minutes).
TAPI-CO is a feasible, efficient, and relatively safe technique for facilitating EA. It provides a simplified alternative to CO insufflation through the coronary sinus. Further studies are needed to confirm these results and to identify the populations of patients that would benefit most from this technique.
心外膜入路（EA）是消融某些心律失常的重要手段，但传统技术存在固有风险。通过冠状窦向心包内注入二氧化碳（CO）旨在促进EA，但耗时且未广泛应用。经心房心包内注入CO（TAPI-CO）提供了一种简化的替代方法，在电生理手术中尚未得到充分探索。
本研究旨在评估TAPI-CO在电生理手术中用于EA的有效性和安全性。
这项回顾性研究纳入了2020年12月至2024年11月在一家三级医疗中心接受TAPI-CO辅助EA的所有患者。该手术包括故意穿刺右心耳以注入CO，随后经剑突下穿刺进行EA。评估成功率、手术特征和并发症。
纳入15例患者（6例房性心律失常和9例室性心律失常）。14例患者（93.3%）成功实施了TAPI-CO，13例（86.7%）实现了剑突下心外膜入路。2例患者（13.3%）存在严重粘连。右心耳穿刺后未观察到明显出血。1例患者（6.7%）出现与TAPI-CO相关的迟发性心包积液。无患者需要手术。手术中位持续时间为265分钟（四分位间距，190 - 288分钟），透视时间为28分钟（四分位间距，24 - 32分钟）。
TAPI-CO是一种可行、高效且相对安全的促进EA的技术。它为通过冠状窦注入CO提供了一种简化的替代方法。需要进一步研究来证实这些结果，并确定最能从该技术中获益的患者群体。
