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Mastering the art of epicardial access in cardiac electrophysiology
- Source :
- Heart Rhythm. 16:1738-1749
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- Access to the epicardial space is fundamental to several cardiac procedures. While traditional indications include catheter ablation of ventricular arrhythmias and accessory pathways, novel indications include left atrial appendage occlusion, esophageal protection, mapping and ablation during atrial fibrillation procedures, implantation of epicardial pacing leads, and phrenic nerve displacement to facilitate safe ablation of atrial and ventricular arrhythmias. Accessing the epicardial space safely is a major challenge requiring intimate knowledge of cardiac anatomy, extensive training, and expertise. Over the past years, multiple technological advances have led to significant improvements in epicardial access success and safety. Important examples of such advances include CO2 insufflation through the coronary sinus or the right atrial appendage, pressure sensor needle, computed tomography, cardiac magnetic resonance, and electroanatomic mapping–guided epicardial access. In addition, we provide special maneuvers to minimize inadvertent right ventricular perforation.
- Subjects :
- Diagnostic Imaging
Epicardial Mapping
Insufflation
medicine.medical_specialty
medicine.medical_treatment
Catheter ablation
030204 cardiovascular system & hematology
Left atrial appendage occlusion
03 medical and health sciences
0302 clinical medicine
Physiology (medical)
Internal medicine
Humans
Medicine
cardiovascular diseases
030212 general & internal medicine
Cardiac Surgical Procedures
Coronary sinus
Phrenic nerve
Cardiac electrophysiology
business.industry
Atrial fibrillation
Ablation
medicine.disease
Heart Injuries
cardiovascular system
Cardiology
Electrophysiologic Techniques, Cardiac
Cardiology and Cardiovascular Medicine
business
Pericardium
Subjects
Details
- ISSN :
- 15475271
- Volume :
- 16
- Database :
- OpenAIRE
- Journal :
- Heart Rhythm
- Accession number :
- edsair.doi.dedup.....fc585c9bc8364fdead043b07a18228c2