The Safety and Efficacy of Epicardial Carbon Dioxide Insufflation Compared With Conventional Epicardial Access.

Background: Epicardial (Epi) access is commonly required during ventricular tachycardia ablation. Conventional Epi (ConvEpi) access targets a "dry" pericardial space presenting technical challenges and risk of complications. Recently, intentional puncture of coronary venous branches with Epi carbon dioxide insufflation (EpiCO ₂ ) has been described as a technique to improve Epi access. The safety of this technique relative to conventional methods remains unproven.
Objectives: The authors sought to compare the feasibility and safety of EpiCO ₂ to ConvEpi access.
Methods: All patients at a high-volume center undergoing Epi access between January 2021 and December 2023 were included and grouped according to ConvEpi or EpiCO ₂ approach. Access technique was according to the discretion of the operator.
Results: Epi access was attempted in 153 cases by 17 different operators (80 ConvEpi vs 73 EpiCO ₂ ). There was no difference in success rate whether the ConvEpi or EpiCO ₂ approach was used (76 [95%] cases vs 67 [91.8%] cases; P = 0.4). Total Epi access time was shorter in the ConvEpi group compared with the EpiCO ₂ group (16.3 ± 11.6 minutes vs 26.9 ± 12.7 minutes; P < 0.001), though the total procedure duration was similar. Major Epi access-related complications occurred in only the ConvEpi group (6 [7.5%] ConvEpi vs 0 [0%] EpiCo ₂ ; P = 0.02). Bleeding ≥80 mL was more frequently observed following ConvEpi access (14 [17.5%] cases vs 4 [5.5%] cases; P = 0.02). After adjusting for age, repeat Epi access, and antithrombotic therapy, EpiCO ₂ was associated with a reduction in bleeding ≥80 mL (OR: 0.27; 95% CI: 0.08-0.89; P = 0.03).
Conclusions: EpiCO ₂ access is associated with lower rates of major complication and bleeding when compared with ConvEpi access.
Competing Interests: Funding Support and Author Disclosures Drs Oraii, Marchlinski, and Hyman are supported by the Leducq Foundation (TNE FANTASY 19CV03). Dr Chaumont also acknowledges the “Fédération Française de Cardiologie,” the “Fondation Charles Nicolle-Normandie,” the “GSC G4,” the “Working Group of Pacing and Electrophysiology of the French Society of Cardiology,” and the “Philippe Foundation.” Dr Hyman has been a consultant for Asahi Intecc, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2024 American College of Cardiology Foundation. All rights reserved.)