Retrospective Observational Study of the Carbon Dioxide Insufflation Technique for Epicardial Access Ablation of Refractory Arrhythmias.

Background/

Objectives

Accessing intramural or epicardial arrhythmogenic substrates is limited in endocardial ablation, and in these circumstances, epicardial ablation may overcome these limitations. Because epicardial access may be associated with severe complications, intentional distal coronary vein exit and carbon dioxide (CO2) insufflation have emerged as techniques to facilitate safer access.

Methods

We conducted a single-centre retrospective observational analysis of all patients who underwent epicardial ablation using the CO2 insufflation technique between September 2021 and October 2024.

Results

Among 21 patients selected for the procedure, successful pericardial access was achieved in 19 (90.5%). The main indication for ablation was ventricular tachycardia (14 patients, 66.7%), and 16 patients (76.2%) had previously undergone endocardial ablation for the same arrhythmia. Most patients had non-ischemic cardiomyopathy (17 patients, 81.0%). Three intra-procedural complications occurred: one (5.3%) was access-related, and two (10.5%) were ablation-related. Early post-procedural complications occurred in three patients (15.8%). Acute procedural success was achieved in 16 of 17 patients (94.1%) who underwent ablation. In-hospital mortality occurred in three cases (15.8%), including one procedure-related death (5.3%).

Conclusions

Intentional coronary vein exit and CO2 insufflation provide a safe and reproducible technique to obtain subxiphoid pericardial access for epicardial ablation.