Arrhythmias & electrophysiologyMeta-analysis
Safety of Carbon Dioxide–Facilitated vs Conventional Epicardial Access
- systematic review, meta-analysis, and meta-regression
- random-effects meta-analyses of proportions and means
- subgroup analyses
Authors' conclusion
Compared with Dry-EPI, EpiCO2 was associated with significantly lower risk of inadvertent ventricular puncture and complications requiring surgery, supporting broader clinical adoption.
Study context
- Population
- Patients undergoing percutaneous epicardial access, mainly for ventricular tachycardia ablationprocedures in 119 studies · EpiCO2 493 · Dry-EPI 8,291
- Participants
- 8,784 patients
- Comparison
- EpiCO2 vs traditional Dry-EPI techniques
- EpiCO2n = 493
- Dry-EPIn = 8,291
Pooled result
As reported in the abstract
Complications requiring surgery
EpiCO2 vs Dry-EPI: P < 0.010 · EpiCO2 vs large-bore needle: P < 0.010 · EpiCO2 vs micropuncture: P = 0.020
Further pooled results
| Outcome | EpiCO2 | Dry-EPI | P value |
|---|---|---|---|
| Inadvertent ventricular puncture · lower with EpiCO2 | 0.28% (95% CI 0.00–1.00) | 3.17% (95% CI 2.36–4.10) | P < 0.010 |
Study characteristics
- Studies of moderate or high quality
- 95.0%
- Ventricular tachycardia ablation as access indication
- n = 7,178
- Dry-EPI cases with specified needle type using a large-bore needle
- 5,184 (89.6%) of 5,786
- Dry-EPI cases with specified needle type using a micropuncture needle
- 602 (10.4%) of 5,786
Original publication
Safety of Carbon Dioxide–Facilitated vs Conventional Epicardial Access. JACC Clin Electrophysiol. Published 6 February 2026. doi:10.1016/j.jacep.2026.01.001
Summarised from the published abstract; every number is checked against it