Abstract
Background: Epicardial access (EA) is increasingly used in various electrophysiological procedures with wide variation in EA success and complications. Methods: A comprehensive search was performed in PubMed, EBSCO and Google Scholar databases for studies reporting success and complications with EA. Meta-analysis was done using MedCalc software with random effects-model. Procedural success was defined as successful pericardial access. Pericardial tamponade was defined as pericardial effusion requiring drainage. Success and complications were adjusted and calculated per 100 procedures. Results: A total of 6 studies [retrospective - 5, prospective - 1] including 1,122 patients [large bore (LB) - 878, micropuncture (MP) - 219 and EpiAcces- 25 patients] undergoing EA for ventricular tachycardia ablation and Lariat procedure. Table 1,2 demonstrates rates of procedural success and complications of EA. Acute procedural success was 94.9% [95% CI (93.1 - 96.1)]. Pericardial tamponade, pericardial effusion, emergency heart surgery and RV puncture were seen in 1.7%, 2.8%, 0.7% and 6.5% respectively. Conclusion: EA is feasible with a 95% procedural success and acceptable rate of major complications. Use of MP needle and advancement in other EA technology will further improve procedure safety.
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