Epicardial access complications during electrophysiology procedures

Area of Science:

• Cardiovascular Medicine
• Electrophysiology

Background:

• Percutaneous epicardial access (EA) has evolved significantly over the past two decades.
• Indications for EA in electrophysiology have expanded substantially.

Purpose of the Study:

• To provide a comprehensive review of cardiac anatomy relevant to EA.
• To outline technical aspects for optimizing epicardial puncture safety.
• To detail the recognition and avoidance of potential complications during EA.

Main Methods:

• Review of existing literature on percutaneous epicardial access.
• Analysis of anatomical considerations for safe epicardial puncture.
• Discussion of techniques for complication avoidance.

Main Results:

• Epicardial mapping and ablation are standard for ventricular tachycardia.
• Epicardial ablation is a potential adjunct for atrial fibrillation post-endocardial ablation.
• EA is essential for certain left atrial appendage occlusion device placements.

Conclusions:

• Accurate cardiac anatomy knowledge is critical for safe EA.
• Understanding potential complications is vital for patient safety.
• This review aims to improve safety and efficacy of epicardial access procedures.