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Pericardial access via wire-guided puncture without contrast: The feasibility and safety of a modified approach
De-Yong Long1, Li-Ping Sun2, Cai-Hua Sang1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Wire-guided pericardial puncture is a safe and effective alternative to contrast-guided access for ventricular tachycardia ablation. This technique shows comparable success rates and a trend towards fewer complications, enhancing patient safety.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Epicardial access is crucial for ventricular tachycardia (VT) ablation.
- Traditional contrast-guided pericardial puncture carries risks.
- Minimizing contrast use is desirable in certain patient populations.
Purpose of the Study:
- To evaluate the feasibility and safety of wire-guided pericardial access without contrast.
- To compare wire-guided versus contrast-guided techniques for epicardial access in VT ablation patients.
Main Methods:
- A retrospective study comparing 73 patients undergoing epicardial access for VT ablation.
- Patients were divided into contrast-guided (32) and wire-guided (41) groups.
- Baseline variables, procedure parameters, and complications were collected and compared.
Main Results:
- Success rates were similar: 30/32 (contrast-guided) vs. 40/41 (wire-guided).
- Fluoroscopy and access times were comparable between groups.
- Inadvertent right ventricular puncture was more frequent in the contrast-guided group (5/32 vs. 1/41).
Conclusions:
- Wire-guided pericardial puncture is a safe and feasible alternative to contrast-guided access.
- The technique demonstrates comparable success rates to contrast-guided methods.
- A trend towards fewer complications suggests improved safety with the wire-guided approach.
Objective:
To investigate the feasibility and safety of wire-guided pericardial access without contrast.
Methods:
From January 2014 to February 2019, patients who received epicardial mapping and ablation of ventricular tachycardia in the Beijing Anzhen Hospital were entered into the current study. They were divided into contrast-guided access group or wire-guided access group according to the pericardial puncture technique used. The baseline variables, procedure parameters, complications were collected and compared.
Results:
During the study period, a consecutive of 73 patients received epicardial access. The initial 32 patients received contrast-guided puncture with success achieved in 30 patients, the remaining 41 patients underwent wire-guided puncture with success achieved in 40 patients (30/32 and 40/41, P = .581). Fluoroscopy time (4.45 ± 0.52 and 4.38 ± 0.46 minutes, P = .891) and access time (5.14 ± 0.58 and 5.34 ± 0.50 minutes, P = .657) were comparable between the two groups. Inadvertent right ventricular puncture occurred more commonly in the contrast-guided group (5/32 and 1/41, P = .038). Though more pericardial effusions (2/32 and 1/41, P = .575), tamponade (2/32 and 1/41, P = .575), and surgical repair (1/32 and 0/41, P = .432) occurred in the contrast-guided group, they reached no statistical difference.
Conclusion:
Wire-guided pericardial puncture exhibits better safety and similar success rates to contrast-guided technique with a trend towards less complications.
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