Experimental efficacy of pericardial instillation of anti-inflammatory agents during percutaneous epicardial catheter ablation to prevent postprocedure pericarditis.
BACKGROUND
Pericarditis is a potential complication of catheter-based percutaneous epicardial mapping and ablation. This study evaluates the efficacy and safety of intrapericardial instillation of anti-inflammatory agents after pericardial mapping and ablation in a porcine model of postprocedural pericarditis.


RESULTS
Twenty-five healthy swine underwent epicardial mapping and ablation after transthoracic subxyphoid puncture. After 60 minutes of continuous catheter manipulation in the pericardial space, radiofrequency energy was delivered in a linear fashion to the epicardial surfaces of both atria. The animals were randomly divided to receive the anti-inflammatory agents, Hyaluronic Acid and Triamcinolone, or control. Fourteen days after ablation, the hearts were excised and the degree of pericardial reaction/adhesions scored. The severity was uniformly graded 4 (intense) in all control animals and was characterized by intense adhesion between the parietal and the visceral pericardium obscuring tissue planes and epicardial anatomy. Hyaluronic Acid provided a mild benefit (score 3.0 +/- 0.9), but 2 mg/kg of Triamcinolone significantly attenuated the inflammatory effect (all animals uniformly scored 1.0).


CONCLUSIONS
In a porcine model of ablation-related pericarditis, intrapericardial instillation of 2 mg/kg of intermediate-acting corticosteroids effectively prevents post-procedure inflammatory adhesion formation.
d'Avila
Andre
A
Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. adavila@partners.org
Neuzil
Petr
P
Thiagalingam
Aravinda
A
Gutierrez
Paulo
P
Aleong
Ryan
R
Ruskin
Jeremy N
JN
Reddy
Vivek Y
VY
D000818:Animals; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D004195:Disease Models, Animal; D007322:Instillation, Drug; D010493:Pericarditis / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D010496:Pericardium; D013552:Swine; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage
D000893:Anti-Inflammatory Agents; D014221:Triamcinolone