Intentional Right Atrial Exit and Carbon Dioxide Insufflation to Facilitate Subxiphoid Needle Entry Into the Empty Pericardial Space: First Human Experience
Greenbaum AB, Rogers T, Paone G, Flynn SE, Guerrero ME, O'Neill WW, Lederman RJ. Intentional right atrial exit and carbon dioxide insufflation to facilitate subxiphoid needle entry into the empty pericardial space: First human experience. JACC Clin Electrophysiol. Oct 2015;1(5):434-441.
JACC Clin Electrophysiol
OBJECTIVES: The purpose of this study was to test whether a microcatheter can safely be advanced across the right atrial appendage to access the pericardium and then withdrawn despite subsequent high-intensity anticoagulation. We also tested whether transatrial pericardial insufflation of carbon dioxide (CO
BACKGROUND: Subxiphoid needle access to the empty pericardium, required for left atrial suture ligation and epicardial ablation for rhythm disorders, risks myocardial or coronary laceration.
METHODS: A catheter from the femoral vein engaged the right atrial appendage for angiographic confirmation of position. Through that catheter, the back end of a 0.014- or 0.018-inch guidewire crossed the right atrial wall to enter the pericardium and delivered a 2.4-F microcatheter. CO
RESULTS: Right atrial exit succeeded in 11 subjects (85%) and failed uneventfully in 2 subjects. CO
CONCLUSIONS: We report the first human intentional transatrial exit procedure. Transatrial microcatheter access to the pericardium can be achieved safely. Pericardial insufflation with CO