Arrhythmias & electrophysiology
A Novel Radiofrequency-Assisted Trans–Right Atrial Appendage (RAA) Perforation Technique for Pericardial CO2 Insufflation to Facilitate Epicardial Access
Authors' conclusion
Intentional RAA perforation for pericardial CO2 insufflation with a custom RF guidewire-microcatheter assembly can be safely and efficiently performed to facilitate epicardial access for ventricular arrhythmias ablation.
Study context
- Population
- Patients undergoing epicardial access for mapping and ablation of ventricular arrhythmias facilitated by pericardial CO2 insufflation via radiofrequency (RF)-assisted RAA microperforation, 2023–2024age: 55 ± 11 years, left ventricular ejection fraction: 44 ± 13%
- Participants
- 18 patients
- Outcome
- Successful RAA exit with the RF guidewire-microcatheter assembly
Main finding
As reported in the abstract
- Achieved in all patients
Observational data: associations, not effects.
Further findings
Epicardial access completed
- Patients with epicardial access completed
- 17 (94%)
- Epicardial access deferred because of significant pericardial adhesions detected after RAA exit
- 1 patient
Time from femoral venous insertion of the catheter assembly to CO2 insufflation
- Median time
- 4 min (range: 3-7 min)
Safety
Significant bleeding (>80 mL)
- Patients with significant bleeding
- 1 patient (patient #3; 150 mL)
- Led to a modification of the technique (shortening of the RF burst to <1 s with 1-2 mm guidewire exposure past the microcatheter and minimal advancement during RF)
Pericardial bleeding after technique modification (n = 15)
- Range
- 5 mL-30 mL
- Median
- 10 mL
- IQR
- 5-20 mL
Inadvertent right ventricle puncture or damage to a coronary artery
- No patient
Pericardial pain after the procedure requiring 1 week of therapy with nonsteroidal anti-inflammatory drugs and colchicine
- Patients
- Three
Original publication
Composed by AI from the published abstract and checked against it. How Briefs are made →