Percutaneous Epicardial Approach to Catheter Ablation of Cardiac Arrhythmias
This review discusses the rationale and indications for epicardial catheter mapping and/or ablation. This paper also reviews the prevalence of epicardial arrhythmias and their electrocardiographic criteria. In addition, it examines the anatomy of the pericardium and commonly used epicardial access techniques, as well as the optimal methodologies for epicardial mapping and ablation and the impact of epicardial fat. Finally, this review discusses the potential of the various complications associated with the percutaneous epicardial approach, in addition to patient specific risk factors, and potential strategies to mitigate the risk of complications.
Editor-in-Chief David J. Wilber, MD, FACC
CME Editor Smit Vasaiwala, MD
AuthorsArash Aryana, MD, PHD
Roderick Tung, MD
CME Information Target Audience JACC Journal CME is intended for physicians who treat patients with cardiovascular disease.
Important Dates Date of Release: January 20, 2020
Term of Approval/Date of CME/MOC/ECME Expiration: January 19, 2021
Learner ObjectivesAfter reading this article the reader should be able to:
- Explain how the critical anatomic substrate in certain patients with cardiac arrhythmias, particularly those with ventricular tachycardia, may occur in intramural or subepicardial myocardium.
- Deduce that successful elimination of these substrates invariably requires epicardial mapping and ablation.
- Illustrate that, despite great similarities between epicardial and endocardial catheter mapping/ablation, there are fundamental differences that can significantly impact this approach within the pericardial space.
- Recognize that knowledge of the regional anatomy and potential risk factors for complications is key to mitigating the risk for adverse events.
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