Temporal Trends in Percutaneous Epicardial Access during Cardiac Ablation Procedures

Ammar Killu1, Siva Mulpuru1, Christopher McLeod1, David Hodge2, Peter Noseworthy1, Thomas Munger1, Douglas Packer1, Samuel Asirvatham1, Paul Friedman1
1 Cardiovascular Diseases, Mayo Clinic, USA
2 Health Sciences Research, Mayo Clinic, USA

Aims: Percutaneous epicardial access (EpiAcc) assists ventricular tachycardia/ premature ventricular complex (VT/PVC) ablation by permitting epicardial mapping and ablation outside the vicinity of the coronary venous system. We hypothesize that with expanding indications and growing operator experience, rates of EpiAcc have been increasing.

Methods and Results: We reviewed the frequency of EpiAcc procedures performed during VT/PVC ablation between 2007-2014 to identify temporal trends in the procedure. There were 758 patients undergoing 880 VT/PVC ablation procedures (95 patients/year; 110 procedures/year) during the study period. EpiAcc for ablation was utilized in 169 patients (180 procedures). The average age at the time of EpiAcc was 55±16 years and128 (76.0%) patients were male. The rate of EpiAcc was 22.9% in males and 15.4% in females (P = 0.008). The absolute number of EpiAcc procedures increased from 2007 (6 procedures) to 2014 (26 procedures). Similarly, proportion of patients undergoing EpiAcc increased from 8.6% of procedures in 2007 to 23.6% in 2014 (P<0.0001). While EpiAcc use became more frequent, the rate of epicardial ablation amongst those who underwent EpiAcc remained stable (approximately 70%).

Conclusion: Percutaneous epicardial access has been used with increasing frequency as part of VT/PVC ablation despite no increase in the rate of epicardial ablation. This growing utilization may lay the foundation for novel epicardial strategies as new technologies emerge.

Change in rate of percutaneous epicardial access during VT/PVC ablation over time