Percutaneous Epicardial Interventions: A Guide for Cardiac Electrophysiologists

Cover
Title Page
Copyright
Dedication
Contents
Foreword
Preface
Contributors
Abbreviations
Video Legends
Chapter 1: Epicardial Interventions in Electrophysiology: Historical Perspectives
INTRODUCTION
ARRHYTHMIA INTERVENTIONS AND RF ABLATION: THE EARLY YEARS
THE CHAGAS DISEASE CHALLENGE
DEVELOPING THE NONSURGICAL EPICARDIALMAPPING TECHNIQUES
EXPANDING THE PROCEDURE
REFERENCES
Chapter 2: Epicardial Anatomy
INTRODUCTION
PERICARDIAL SAC
PERICARDIAL SINUSES
PERICARDIAL RECESSES
PERICARDIAL AND EPICARDIAL FAT
PERICARDIAL NERVE SUPPLY
PERICARDIAL ANOMALIES
CONCLUSION
REFERENCES
Chapter 3: Inferior and Anterior Approaches Using a Tuohy Needle
INTRODUCTION
ACCESSING THE PERICARDIUM
SUBXIPHOID APPROACH
INFERIOR PUNCTURE
ANTERIOR PUNCTURE
CONCLUSION
REFERENCES
Chapter 4: Micropuncture Needle for Epicardial Access
INTRODUCTION
RATIONALE FOR MICROPUNCTURE ACCESS
TECHNIQUE OF NEEDLE-IN-NEEDLE MICROPUNCTURE EPICARDIAL ACCESS
OUTCOMES OF THE NEEDLE-IN-NEEDLE APPROACH
FUTURE DIRECTIONS
REFERENCES
Chapter 5: Pressure Sensor Needle for Epicardial Access
INTRODUCTION
NEEDLE DESCRIPTION
CLINICAL DATA: EFFICACY AND SAFETY
REFERENCES
Chapter 6: Different Fluoroscopic Approaches for Epicardial Access
INTRODUCTION
FLUOROSCOPIC ASSESSMENT AND COMPLICATIONS
FLUOROSCOPIC SETTINGS
FLUOROSCOPIC ANGLES
EPICARDIAL ACCESS IN OUR INSTITUTION
CONCLUSION
REFERENCES
Chapter 7: Epicardial Access for Left Atrial Appendage Occlusion: Techniques and Challenges
INTRODUCTION
ANATOMICAL CONSIDERATIONS ANDPREPROCEDURAL PLANNING
PERICARDIAL ACCESS TECHNIQUE
POTENTIAL CHALLENGES
POTENTIAL COMPLICATIONS
PREVENTION OF COMPLICATIONS
CONCLUSION
REFERENCES
Chapter 8: Epicardial Access in Anticoagulated Patients
INTRODUCTION
EPICARDIAL ACCESS ON ANTICOAGULATION
CONCLUSION
REFERENCES
Chapter 9: Epicardial Ablation After Prior Open-Chest Surgery or Percutaneous Epicardial Procedures
INTRODUCTION
LIMITED EPICARDIAL MAPPING FROM THE CORONARY VENOUS SYSTEM
PERCUTANEOUS ACCESS WITH LIMITED EPICARDIAL MAPPING
MICROPUNCTURE ACCESS
PREPROCEDURAL IMAGING
COMPLICATIONS
CONCLUSION
REFERENCES
Chapter 10: Surgical Window for Epicardial Ablation
INTRODUCTION
PREPROCEDURAL PLANNING
CREATION OF THE SURGICAL WINDOW
KEY CONSIDERATIONS FOR EPICARDIAL ABLATION USING A SURGICAL WINDOW
COMPLICATIONS
CONCLUSION
REFERENCES
Chapter 11: Totally Endoscopic Robotic Epicardial Surgical Ablation (TERESA) Procedure to Treat Arrhythmias from the Left Ventriular Summit
INTRODUCTION
RATIONALE
PRIOR SURGICAL APPROACHES
SURGICAL SETUP
MAPPING AND ABLATION
POSTPROCEDURAL MANAGEMENT
CONCLUSION
REFERENCES
Chapter 12: Beyond Ablation: Other Potential Roles for Epicardial Access
INTRODUCTION
PERICARDIOSCOPY TO ENHANCE ARRHYTHMIAMANAGEMENT
INTRAPERICARDIAL DRUG DELIVERY
STRUCTURAL INTERVENTIONS
AUTONOMIC INTERVENTIONS
EPICARDIAL LEAD PLACEMENT
CONCLUSION
REFERENCES
Chapter 13: Effect of Fat on Electrogram Interpretation
INTRODUCTION
EPICARDIAL FAT
DIFFERENTIATING FAT FROM SCAR
EFFECT ON ABLATION OUTCOMES
CONCLUSION
REFERENCES
Chapter 14: Magnetic Resonance Imaging: Role and Limitations
INTRODUCTION
CARDIAC MAGNETIC RESONANCE METHODS
SPECTRUM OF CARDIAC MRI FINDINGS IN PATIENTS WITH SUBEPICARDIAL SCARS
CARDIAC MRI FOR THE PLANNING AND GUIDANCE OF EPICARDIAL ABLATION PROCEDURES
CHALLENGES OF AN EPICARDIAL ACCESS
CARDIAC MRI-BASED SUBSTRATE MAPPING TO GUIDE ABLATION PROCEDURES
CARDIAC MRI LIMITATIONS
CONCLUSION
REFERENCES
Chapter 15: Intracardiac Echocardiography: Identification of Substrate and Role in Ablation
INTRODUCTION
AVAILABLE ICE SYSTEMS
STANDARD ECHOCARDIOGRAPHIC VIEWS
GUIDANCE OF PERCUTANEOUS EPICARDIAL ACCESS
USE OF ICE FOR IDENTIFICATION OF EPICARDIAL SUBSTRATE
MONITORING OF CATHETER POSITION AND LESION FORMATION
INTEGRATION WITH ELECTROANATOMIC MAPPING SYSTEMS
DETECTION AND PREVENTION OF COMPLICATIONS
REFERENCES
Chapter 16: Unipolar Identification of Scar: The Basics
INTRODUCTION
ENDOCARDIAL UNIPOLAR MAPPING TO IDENTIFY THE EPICARDIAL VT ANATOMIC SUBSTRATE
CONCLUSIONS
REFERENCES
Chapter 17: Effect of Transmural Scar & Hypertrophy on Identifying Epicardial Substrate with Unipolar Endocardial Recording
INTRODUCTION
TYPES OF SCAR: PRESENCE, EXTENT, AND TRANSMURALITY
DIAGNOSTIC UTILITY OF UNIPOLAR VOLTAGE MAPPING
PROGNOSTIC UTILITY OF UNIPOLAR VOLTAGE MAPPING
EFFECT OF HYPERTROPHY ON UNIPOLAR VOLTAGES
UNIPOLAR ELECTROGRAMS AND INTRAMURAL SEPTAL SUBSTRATE MAPPING
CONCLUSION
REFERENCES
Chapter 18: Compartmentalization of the Endocardium Versus the Epicardium
INTRODUCTION
POTENTIAL FOR EPICARDIAL COMPARTMENTALIZATION DURING SCAR-RELATED VT
NORMAL EPICARDIAL ACTIVATION SEQUENCE RELATIVE TO ENDOCARDIUM
POTENTIAL FOR COMPARTMENTALIZED EPICARDIAL SINUS RHYTHM ACTIVATION
IMPLICATIONS FOR EPICARDIAL VT IN ARVC
FUTURE DIRECTIONS
CONCLUSIONS
REFERENCES
Chapter 19: Electrocardiographic Criteria to Identify Epicardial Idiopathic Ventricular Tachycardia
INTRODUCTION
VENTRICULAR TACHYCARDIA LOCALIZING CLUES
THE LEFT VENTRICULAR SUMMIT
CARDIAC CRUX
CONCLUSION
REFERENCES
Chapter 20: Nonischemic Ventricular Tachycardia
INTRODUCTION
ECG CRITERIA SUGGESTING AN EPICARDIAL VT ORIGIN IN LV NONISCHEMIC CARDIOMYOPATHY
ECG CRITERIA SUGGESTING AN EPICARDIAL VT ORIGIN IN RV CARDIOMYOPATHY
PROSPECTIVE VALIDATION OF INTERVAL AND MORPHOLOGICAL CRITERIA
CONCLUSION
REFERENCES
Chapter 21: Ischemic Ventricular Tachycardia: Limitations of the Electrocardiogram
INTRODUCTION
RELATION BETWEEN EXITS AND REENTRY CIRCUITS IN INFARCT-RELATED VT
ECG CANNOT ALWAYS DISTINGUISH EPICARDIAL FROM ENDOCARDIAL VTS
UTILITY OF ECG
CONCLUSION
REFERENCES
Chapter 22: Sinus Rhythm Clues to Presence of Epicardial Substrate
INTRODUCTION
CONCLUSION
REFERENCES
Chapter 23: Depolarization Abnormalities in Arrhythmogenic Right Ventricular Cardiomyopathy
INTRODUCTION
PATHOPHYSIOLOGY OF DEPOLARIZATION CHANGES IN ARVC
DEPOLARIZATION ABNORMALITIES IN ARVC
DEPOLARIZATION ABNORMALITIES AND RISK STRATIFICATION IN ARVC
CONCLUSION
REFERENCES
Chapter 24: Endocardial and Epicardial Anatomic Correlates of Repolarization Abnormalities in Arrhythmogenic Right Ventricular Dysplasia
INTRODUCTION
SURFACE ECG REPOLARIZATION ABNORMALITIES AND ELECTROANATOMIC SUBSTRATE
ANALYSIS OF VENTRICULAR REPOLARIZATIONUSING DIRECT UNIPOLAR ENDOCARDIAL AND EPICARDIAL RECORDINGS
REFERENCES
Chapter 25: Endocardial and Epicardial Anatomic Correlates of Electrocardiographic Depolarization Abnormalities in Nonischemic Cardiomyopathy
INTRODUCTION
COMMON ECG FINDINGS IN NONISCHEMIC DILATED CARDIOMYOPATHY
ECG CORRELATES OF ELECTROANATOMIC ABNORMALITIES
CONCLUSION
REFERENCES
Chapter 26: Epicardial Anatomic Correlates of Electrocardiographic Abnormalities in Brugada Syndrome
INTRODUCTION
BRUGADA SYNDROME HISTORICAL PRECEDENTS
THE DISCOVERY OF THE BRUGADA SUBSTRATE
EPICARDIAL BRUGADA SUBSTRATE DRIVING ELECTROMECHANICAL CHANGES
A NOVEL 3D MULTIMODALITY APPROACH
ELECTROANATOMIC MAPPING
RV MECHANICAL IMAGING
AJMALINE PROVOCATION TO UNMASK EPICARDIAL BRUGADA SUBSTRATES
EPICARDIAL ABLATION OF BRUGADA SUBSTRATE
THE ROLE OF BRUGADA SUBSTRATE IN PATHOPHYSIOLOGY AND OUTCOME OF BRS
CONCLUSION
REFERENCES
VIDEO LEGENDS
Chapter 27: Multielectrode Epicardial Mapping
INTRODUCTION
HISTORICAL PERSPECTIVES
SUGGESTED WORKFLOW
REFERENCES
Chapter 28: Ablation of Epicardial Substrate and Ventricular Tachycardia Through Endocardial Ablation
INTRODUCTION
ABLATION STRATEGY
RESULTS OF EPI-LAVA ELIMINATION THROUGH ENDOCARDIAL ABLATION
UNDERLYING STRUCTURAL HEART DISEASE
CONCLUSION
REFERENCES
Chapter 29: Surgical Epicardial Ablation
INTRODUCTION
INDICATIONS FOR SURGICAL EPICARDIAL ABLATION
MAPPING AND ABLATION IN THE OPERATING ROOM
ABLATION ENERGY SOURCES FOR SURGICAL ABLATION
ENDPOINTS OF SURGICAL ABLATION
SURGICAL VT ABLATION FOR NONISCHEMIC CARDIOMYOPATHY: THE PENN EXPERIENCE
CONCLUSION
REFERENCES
VIDEO LEGENDS
Chapter 30: Epicardial Ablation of Sustained Ventricular Tachycardia in Patients with Chagas Heart Disease
INTRODUCTION
CARDIAC ARRHYTHMIAS AND SUDDEN DEATH IN CHRONIC CHAGAS HEART DISEASE
IMAGING IN CHAGAS DISEASE
TREATMENT OF VENTRICULAR TACHYCARDIA IN PATIENTS WITH CHAGAS HEART DISEASE
RESULTS OF CHAGAS VT ABLATION
REFERENCES
Chapter 31: Epicardial Ventricular Tachycardia Mapping and Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy
INTRODUCTION
PATIENT SELECTION
PROCEDURAL APPROACH: ENDOCARDIAL MAPPING AND ABLATION
PROCEDURAL APPROACH: EPICARDIAL MAPPING AND ABLATION
PROCEDURAL ENDPOINTS
DISEASE PROGRESSION
CONCLUSION
REFERENCES
Chapter 32: Do We Need Epicardial Ablation in All Patients with Arrhythmogenic Right Ventricular Cardiomyopathy?
INTRODUCTION
ENDOCARDIAL ABLATION IN ARVC
ENDOCARDIAL–EPICARDIAL ABLATION AFTER PREVIOUSLY FAILED ENDOCARDIAL PROCEDURE
FIRST-LINE ENDOCARDIAL–EPICARDIAL ABLATION
ENDOCARDIAL AND ADJUVANT EPICARDIAL SUBSTRATE ABLATION
REFERENCES
Chapter 33: Hypertrophic Cardiomyopathy
INTRODUCTION
MECHANISMS OF VENTRICULAR ARRHYTHMIAS
PREABLATION EVALUATION
ABLATION PROCEDURE
CLINICAL OUTCOMES
POSTPROCEDURE MANAGEMENT
CONCLUSION
REFERENCES
Chapter 34: Ischemic Cardiomyopathy
INTRODUCTION
EPICARDIAL VT SUBSTRATE IN ISCHEMIC HEART DISEASE
INDICATIONS TO EPICARDIAL APPROACH AND ABLATION: EVIDENCE FROM THE LITERATURE
WHEN IS EPICARDIAL ABLATION REQUIRED? OUR EXPERIENCE
SPECIFIC ISSUE OF EPICARDIAL ACCESS IN ISCHEMIC PATIENTS: PERFORMING EPICARDIAL APPROACH ON DUAL ANTIPLATELET THERAPY
REFERENCES
Chapter 35: Sarcoidosis and Other Granulomatous Diseases
INTRODUCTION
CLINICAL AND ELECTROPHYSIOLOGIC CHARACTERISTICS OF VT IN GRANULOMATOUS MYOCARDITIS
AUTHORS’ EXPERIENCE
EPICARDIAL MAPPING AND ABLATION TECHNIQUE
CONCLUSION
REFERENCES
Chapter 36: Epicardial Catheter Ablation of Ventricular Tachycardia: A Meta-Analysis
INTRODUCTION
MATERIAL AND METHODS
RESULTS
DISCUSSION
CONCLUSION
REFERENCES
Chapter 37: Epicardial Mapping and Ablation of Premature Ventricular Complexes
INTRODUCTION
LEFT VENTRICULAR SUMMIT ANATOMY
ELECTROCARDIOGRAPHIC CHARACTERISTICS
MAPPING AND ABLATION
CONCLUSION
REFERENCES
Chapter 38: Percutaneous Catheter Ablation of Epicardial Accessory Pathways
INTRODUCTION
ACCESSORY PATHWAY ABLATION
ENDOCARDIAL ABLATION
INTRAVENOUS MAPPING AND ABLATION
PERCUTANEOUS EPICARDIAL MAPPING AND ABLATION
CLINICAL PERSPECTIVES
REFERENCES
Chapter 39: Epicardial Fat
INTRODUCTION
EPICARDIAL FAT
IMPACT ON EPICARDIAL ELECTROGRAM
IMPACT ON IMPEDANCE
IMPACT ON EPICARDIAL ABLATION
NEURONAL MODULATION
FAT NECROSIS
CONCLUSION
REFERENCES
Chapter 40: Impact of Irrigation Flow Rate and Intrapericardial Fluid
INTRODUCTION
IMPACT OF IRRIGATION FLOW RATES
IMPACT OF IPF
ALTERNATE IRRIGATION SOLUTIONS
CONCLUSION
REFERENCES
Chapter 41: Alternate Irrigation Solutions for Radiofrequency Ablation and Alternative Energy Sources
INTRODUCTION
STANDARD RF ABLATION EXTERNALLY COOLED WITH LOW-IONIC IRRIGANTS
ALTERNATIVE ENERGY SOURCES FOR EPICARDIAL ABLATION
CONCLUSION
REFERENCES
Chapter 42: Risk Factors for Percutaneous Epicardial Access Complications and Strategies for Management
INTRODUCTION
RISK FACTORS FOR DAMAGE TO THE EXTRACARDIAC ORGANS
RISK FACTORS FOR CARDIAC PUNCTURE AND TAMPONADE
PRIOR CARDIAC SURGERY
ADHESIONS DISCOVERED DURING PERCUTANEOUS EPICARDIAL ACCESS ATTEMPTS
SURGICAL STRATEGIES WHEN PERCUTANEOUS EPICARDIAL ACCESS FAILS
SUMMARY
REFERENCES
VIDEO LEGENDS
Chapter 43: Hemopericardium
INTRODUCTION
PREPROCEDURAL PLANNING AND EPICARDIAL ACCESS
CLASSIFICATION OF HEMOPERICARDIUM
MANAGEMENT OF HEMOPERICARDIUM
CONCLUSION
REFERENCES
Chapter 44: Intra-Abdominal Bleeding
INTRODUCTION
VASCULAR INJURY
HEPATIC INJURY
INTRA-ABDOMINAL BLEEDING
MITIGATING RISK
CONCLUSION
REFERENCES
Chapter 45: Vascular and Phrenic Nerve Injury and Protection
INTRODUCTION
EPIDEMIOLOGY
VASCULAR INJURY: PATHOPHYSIOLOGY AND CLINICAL MANIFESTATIONS
PHRENIC NERVE INJURY: PATHOPHYSIOLOGY AND CLINICAL MANIFESTATIONS
TECHNIQUES TO AVOID VASCULAR AND PHRENIC NERVE INJURY
CONCLUSIONS
REFERENCES
Chapter 46: Esophageal Injury: Recognition and Prevention
INTRODUCTION
PREVENTION METHODS
CONCLUSION
REFERENCES
Chapter 47: Unusual Complications
INTRODUCTION
VASCULAR INJURY
MYOCARDIAL INJURY
GUIDEWIRE DISLODGEMENT
HEPATIC INJURY
INTRA-ABDOMINAL HEMORRHAGE AND INJURY
PHRENIC NERVE INJURY
RIGHT VENTRICULAR PSEUDOANEURYSM
CARDIO-ABDOMINAL FISTULA
PLEURAL INJURY
INCREASED DEFIBRILLATION THRESHOLD
RECURRENT PERICARDITIS AND DELAYED PERICARDIAL EFFUSION
CONSTRICTIVE PERICARDITIS
CONCLUSION
REFERENCES
Disclosures
Index