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Insights on Carbon Dioxide Insufflation Technique for Epicardial Access Ablation of Refractory Arrhythmias: safety and clinical outcomes
Session:
SESSÃO DE POSTERS 44 - ARRITMIAS VENTRICULARES
Speaker:
Leonor Magalhães
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.4 Ventricular Arrhythmias and SCD - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Leonor Magalhães; Margarida Figueiredo; Sofia Jacinto; Guilherme Portugal; Paulo Osório; Helder Santos; Bruno Valente; Ana Lousinha; Pedro Silva Cunha; Rui Ferreira; Mário Martins Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Epicardial access ablation is a key intervention for treating recurrent arrhythmias with epicardial substrates. However, the standard approach carries risks of major complications. A novel technique using pericardial CO2 insufflation, facilitated by the intentional coronary venous exit for subxiphoid puncture, enhances the access to epicardial space. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><strong>Methods</strong>: Analysis of consecutive patients (P) who underwent epicardial ablation for recurrent symptomatic arrhythmias between September 2019 and October 2024. The primary objective was to assess the safety and feasibility of CO2-assisted pericardial access. Data collected included demographics, procedural details, and follow-up outcomes.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><strong>Results</strong>: 17P underwent epicardial access using CO2 insufflation: 13P for ventricular tachycardia (VT) and 4P for non-VT arrhythmias (left atypical atrial flutter, lateral posterior accessory pathway, and ventricular ectopias). There were 14 men (82.4%) and the median age was 64 years [IQR 39–73]). Underlying diagnoses included dilated cardiomyopathy (52%), arrhythmogenic right cardiomyopathy (23.5%) and hypertrophic cardiomyopathy (11.8%). Implanted devices (ICD or CRT-D) were present in 88%. Nine procedures were urgent due to electrical storms or recurrent VT episodes. In 7P, epicardial ablation was complemented with endocardial applications. Only 3 were first-intention ablations; 76.5% had prior failed ablations. Median radiofrequency time (RF) was 29 minutes (IQR 10–40) and fluoroscopy time was 20 minutes (IQR 16–32). Acute access-related complications (1 minor haemorrhage) occurred in 1P (5.8%). The later intraprocedural complications (11.7%) were related to the ablation process itself: 1 reversed cardiac arrest due to VT induction and 1 left ventricular myocardial perforation due to endocardial RF application, which proved fatal. Another death occurred due to electric storm recurrence with cardiogenic shock. </span></span></span></span><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">All 15 patients who completed ablation achieved acute success. Over a median follow-up of 265 days (IQR 56–977), 3P (20%) had arrhythmia recurrence.</span></span></span></span></p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> CO2-assisted pericardial access for ablation of both VT and non-VT arrhythmias is a safe and reproducible technique associated with a low complication rate. This initial data supports the ability to undergo endo-epicardial strategies as a first-line option.</span></span></p>
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