Percutaneous Access of the Epicardial Space for Mapping Ventricular and Supraventricular Arrhythmias in Patients With and Without Prior Cardiac Surgery

INTRODUCTION: There is a paucity of data on the success rates of achieving percutaneous epicardial access in different groups of patients. METHODS AND RESULTS: Percutaneous epicardial access was attempted in 137 patients having 149 procedures; 19 patients had supraventricular tachycardia (SVT), 25 patients had idiopathic VT and 93 patients had scar-related ventricular tachycardia (VT). Ten patients had prior cardiac surgery. Successful epicardial access was achieved in 133 of 149 (89.3%) procedures. Access was achieved in 17 of 19 (89.5%) patients with SVT, all patients with idiopathic VT, 80 of 93 (86.0%) patients with scar-related VT and in 2 (20%) patients with prior cardiac surgery. Attempted access failed in 16 patients; 8 had prior cardiac surgery and 3 had prior pericarditis. After an initial procedure, repeat access was attempted in 15 patients, 5.1 +/- 5.4 months after initial epicardial mapping and ablation. Access was successful in 13 (86.7%) and failed in 2 patients who had pericarditis after their first procedure. Only 4 patients were given intrapericardial glucocorticoid at their first epicardial procedure. Prior cardiac surgery and a history of pericarditis predicted unsuccessful access (P < 0.01). Complications (9 patients) included pericardial bleeding (80-250 mL) and intraabdominal bleeding. CONCLUSIONS: In patients without prior cardiac surgery, percutaneous epicardial access can be obtained in the majority of patients. Prior cardiac surgery precludes access in the most patients and when possible adhesions may limit catheter movement. Repeat access is possible in the majority of patients without the installation of intrapericardial glucocorticoid at the first procedure.