Key result
CO2 insufflation for epicardial access achieves ~91% access success in an observational cohort.
Why the study?
Epicardial ablation can overcome limitations of endocardial ablation for intramural or epicardial arrhythmogenic substrates, but epicardial access may cause severe complications, prompting evaluation of CO2 insufflation techniques for safer access.
Does epicardial access using intentional distal coronary vein exit and carbon dioxide (CO2) insufflation provide safe and successful access in patients undergoing epicardial ablation for refractory arrhythmias?
Observational (n=21)
No
Does epicardial access using intentional distal coronary vein exit and carbon dioxide (CO2) insufflation provide safe and successful access in patients undergoing epicardial ablation for refractory arrhythmias?
Intentional coronary vein exit with CO2 insufflation is a feasible technique for achieving epicardial access in refractory arrhythmias, demonstrating high procedural success but carrying notable procedural risks.
May facilitate epicardial access in refractory arrhythmias; leaves open safety questions before wider adoption.
Background/Objectives: Accessing intramural or epicardial arrhythmogenic substrates is limited in endocardial ablation, and in these circumstances, epicardial ablation may overcome these limitations. Because epicardial access may be associated with severe complications, intentional distal coronary vein exit and carbon dioxide (CO2) insufflation have emerged as techniques to facilitate safer access. Methods: We conducted a single-centre retrospective observational analysis of all patients who underwent epicardial ablation using the CO2 insufflation technique between September 2021 and October 2024. Results: Among 21 patients selected for the procedure, successful pericardial access was achieved in 19 (90.5%). The main indication for ablation was ventricular tachycardia (14 patients, 66.7%), and 16 patients (76.2%) had previously undergone endocardial ablation for the same arrhythmia. Most patients had non-ischemic cardiomyopathy (17 patients, 81.0%). Three intra-procedural complications occurred: one (5.3%) was access-related, and two (10.5%) were ablation-related. Early post-procedural complications occurred in three patients (15.8%). Acute procedural success was achieved in 16 of 17 patients (94.1%) who underwent ablation. In-hospital mortality occurred in three cases (15.8%), including one procedure-related death (5.3%). Conclusions: Intentional coronary vein exit and CO2 insufflation provide a safe and reproducible technique to obtain subxiphoid pericardial access for epicardial ablation.
No takes yet. Share an insight, caveat, or question.
Figueiredo et al. (2025) conducted an observational in Refractory Arrhythmias (n=21). Carbon dioxide (CO2) insufflation technique was evaluated on Successful pericardial access. The carbon dioxide insufflation technique for epicardial access achieved successful pericardial access in 90.5% of patients and acute procedural success in 94.1% of those undergoing ablation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: