Successful Percutaneous Epicardial Access in Challenging Scenarios

摘要: Background This case-series highlights strategies used for successful epicardial access in challenging cases. Percutaneous has become a valuable tool mapping and ablating arrhythmias. However, this technique can be especially difficult certain circumstances is frequently avoided. Methods All cases of ablation from our institution were reviewed searching exceptionally patients with complex pericardial thoracic anatomy. The are characterized report. Results Among 144 who underwent an procedure between January 2004 June 2013, four required unconventional approaches ventricular tachycardia ablation. Two (one previous cardiac surgery one prior effusion) had substantial fibrous adhesions no virtual space adhesiolysis. One patient, status postpartial colectomy, computed tomography-guided intercostal due to the presence bowel throughout subdiaphragmatic upper abdomen. fourth patient partial congenital absence pericardium through creation subxiphoid window. All accesses performed without major complication. Conclusions With precise procedural planning imaging, percutaneous feasible even significant anatomical challenges.