Arrhythmias & electrophysiologyResearch article
Identifying the optimal site for intentional right atrial appendage perforation for pericardial CO2 insufflation: A cardiac CT anatomic evaluation
- cardiac CT anatomic evaluation
- contrast-enhanced cardiac computed tomography
- consecutive patients
Authors' conclusion
The high septal anterior RAA offers the most favorable anatomic clearance for transatrial pericardial access, whereas the lateral and remaining septal walls lie in close proximity to the parietal pericardium and aorta.
Study context
- Population
- Patients undergoing contrast-enhanced cardiac computed tomographyconsecutive patients (24 men, 57 ± 12 years), additional validation cohort of 8 patients undergoing trans-RAA carbon dioxide insufflation and 2 patients with aortic dilation
- Participants
- 50 patients
- Comparison
- Distances from RAA segments to adjacent epicardial structures
Main finding
As reported in the abstract
Distance from lateral RAA segments to parietal pericardium
Lateral RAA segments directly contacted the parietal pericardium
0 mm [interquartile range 0-0 mm]
Further findings
Distance from posterior and midseptal segments to aorta
- Posterior and midseptal segments closely approximated the aorta
- 3.8 mm [2.3-8.2 mm]
Visible pericardial space
- Only the septal anterior region bordered a visible pericardial space between the parietal pericardium, aorta, right coronary artery (RCA), and right ventricular outflow tract
Separations at the high septal anterior plane
mm
- right ventricular outflow tract
- 12.4
- aorta
- 6.3
- parietal pericardium
- 9.8
- RCA
- 13.4
- greatest separations
RCA branches within 5 mm of the RAA
- patients with RCA branches coursing within 5 mm of the RAA
- 4
Validation cohort
- Results were consistent in an additional validation cohort of 8 patients undergoing trans-RAA carbon dioxide insufflation and 2 patients with aortic dilation
Original publication
Identifying the optimal site for intentional right atrial appendage perforation for pericardial CO2 insufflation: A cardiac CT anatomic evaluation. Heart Rhythm. Published 25 February 2026. doi:10.1016/j.hrthm.2026.02.026
Summarised from the published abstract; every number is checked against it