Heart rhythm · 2025
Transatrial pericardial insufflation of carbon dioxide to facilitate epicardial mapping and ablation of atrial and ventricular arrhythmias.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ditac Geoffroy, Verhaeghe Laurens, Pambrun Thomas, Benali Karim, Johner Nicolas, Kneizeh Kinan, Plant Allan, Fitzgerald John L, Vlachos Konstantinos, Sacristan Benjamin, Charton Jan, Arnaud Marine, Bouyer Benjamin, Tixier Romain, Derval Nicolas, Hocini Mélèze, Haïssaguerre Michel, Jaïs Pierre, Sacher Frédéric, Duchateau Josselin
Аннотация
BACKGROUND: Epicardial access (EA) is an essential tool for ablation of certain arrhythmias, but conventional techniques carry inherent risks. Carbon dioxide (CO2) insufflation in the pericardium through the coronary sinus aims to facilitate EA but is time-consuming and not widely used. Transatrial pericardial insufflation of CO2 (TAPI-CO2) offers a simplified alternative, underexplored in electrophysiology procedures.
OBJECTIVE: This study aimed to evaluate the efficacy and safety of TAPI-CO2 for EA in electrophysiology procedures.
METHODS: This retrospective study included all patients undergoing EA with TAPI-CO2 at a tertiary care center between December 2020 and November 2024. The procedure involved intentional right atrial appendage perforation for CO2 insufflation, followed by subxiphoid puncture for EA. Success rates, procedural characteristics, and complications were assessed.
RESULTS: Fifteen patients (6 with atrial arrhythmias and 9 with ventricular arrhythmias) were included. TAPI-CO2 was successfully performed in 14 patients (93.3%), and subxiphoid EA was achieved in 13 (86.7%). There were major adhesions in 2 patients (13.3%). No significant bleeding was observed after right atrial appendage perforation. One patient (6.7%) had delayed pericardial effusion related to TAPI-CO2. No patient required surgery. Median procedural duration was 265 minutes (interquartile range, 190-288 minutes), and fluoroscopy time was 28 minutes (interquartile range, 24-32 minutes).
CONCLUSION: TAPI-CO2 is a feasible, efficient, and relatively safe technique for facilitating EA. It provides a simplified alternative to CO2 insufflation through the coronary sinus. Further studies are needed to confirm these results and to identify the populations of patients that would benefit most from this technique.
OBJECTIVE: This study aimed to evaluate the efficacy and safety of TAPI-CO2 for EA in electrophysiology procedures.
METHODS: This retrospective study included all patients undergoing EA with TAPI-CO2 at a tertiary care center between December 2020 and November 2024. The procedure involved intentional right atrial appendage perforation for CO2 insufflation, followed by subxiphoid puncture for EA. Success rates, procedural characteristics, and complications were assessed.
RESULTS: Fifteen patients (6 with atrial arrhythmias and 9 with ventricular arrhythmias) were included. TAPI-CO2 was successfully performed in 14 patients (93.3%), and subxiphoid EA was achieved in 13 (86.7%). There were major adhesions in 2 patients (13.3%). No significant bleeding was observed after right atrial appendage perforation. One patient (6.7%) had delayed pericardial effusion related to TAPI-CO2. No patient required surgery. Median procedural duration was 265 minutes (interquartile range, 190-288 minutes), and fluoroscopy time was 28 minutes (interquartile range, 24-32 minutes).
CONCLUSION: TAPI-CO2 is a feasible, efficient, and relatively safe technique for facilitating EA. It provides a simplified alternative to CO2 insufflation through the coronary sinus. Further studies are needed to confirm these results and to identify the populations of patients that would benefit most from this technique.