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Published on: February 26, 2013
Percutaneous transhepatic access for catheter ablation of cardiac arrhythmias
Duy Thai Nguyen1, Rajan Gupta, Joseph Kay
1Electrophysiology, University of Colorado, Anschutz Medical Campus, 12401 E. 17th Avenue, B-132, Aurora, CO 80045, USA. duy.t.nguyen@ucdenver.edu
Insights
Percutaneous transhepatic access offers a safe alternative for cardiac ablation when femoral venous access is challenging. This method successfully treated various arrhythmias in six patients, achieving long-term freedom from symptoms.
Area of Science:
- Cardiovascular Medicine
- Electrophysiology
- Interventional Cardiology
Background:
- Standard femoral venous access for electrophysiology (EP) studies and cardiac ablation can be difficult in some patients.
- Alternative access routes are crucial for successful arrhythmia management in these cases.
Purpose of the Study:
- To evaluate the safety and feasibility of percutaneous transhepatic access for EP study and ablation.
- To assess the efficacy of this approach in patients with limited venous access.
Main Methods:
- Six patients with cardiac arrhythmias and venous abnormalities underwent percutaneous transhepatic access.
- Procedures were guided by fluoroscopy and ultrasound, involving transhepatic needle insertion and vascular sheath placement.
- Electrophysiology study and radiofrequency ablation were performed via the transhepatic route.
Main Results:
- All tachycardias, including atrial tachycardia, atrial flutter, atrioventricular nodal tachycardia, and atrial fibrillation, were successfully ablated.
- Procedural and fluoroscopy times were recorded (227-418 min and 32-95 min, respectively).
- No complications occurred, and all six patients remained arrhythmia-free during follow-up (mean 23.1 months).
Conclusions:
- Percutaneous transhepatic access is a safe and effective alternative for patients requiring EP study and ablation with limited venous access.
- This technique facilitates comprehensive treatment for a variety of cardiac arrhythmias.
Aims:
Femoral venous access may be limited in certain patients undergoing electrophysiology (EP) study and ablation. The purpose of this study is to review a series of patients undergoing percutaneous transhepatic access to allow for ablation of cardiac arrhythmias.
Methods And Results:
Six patients with a variety of cardiac arrhythmias and venous abnormalities underwent percutaneous transhepatic access. Under fluoroscopic and ultrasound guidance, a percutaneous needle was advanced into a hepatic vein and exchanged for a vascular sheath over a wire. Electrophysiology study and radiofrequency ablation was then performed. All tachycardias, including atrial tachycardia, atrial flutter, atrioventricular nodal tachycardia, and atrial fibrillation, were ablated. Procedural times ranged from 227 to 418 min. Fluoroscopy times ranged from 32 to 95 min. There were no complications. All six patients have been arrhythmia-free in follow-up (5-49 months, mean 23.1 months).
Conclusion:
Percutaneous transhepatic access is safe and feasible in patients with limited venous access who are undergoing EP study and ablation for a range of cardiac arrhythmias.
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