title: Unusual complications of percutaneous epicardial access and epicardial mapping and ablation of cardiac arrhythmias.
abstract: BACKGROUND
  Percutaneous epicardial access and mapping/ablation of cardiac arrhythmias are being increasingly performed. Although complications such as pericardial effusion are relatively common, other unusual complications may occur due to the complex anatomic architecture of the heart and surrounding tissues. In this report, we report a series of rare and unusual complications related to percutaneous epicardial procedures.
  
  
  RESULTS
  Between 2006 and 2011, 334 patients underwent attempts at percutaneous, subxiphoid access for epicardial mapping/ablation at 5 experienced centers. Seven selected complications are highlighted in this case series. Patient 1 had a 1-cm right ventricular pseudoaneurysm after several unsuccessful attempts at epicardial access. This was successfully managed conservatively. Patient 2 had intra-abdominal bleeding related to puncture of the left lobe of the liver during access that required surgical repair. Patient 3 had a subcapsular hepatic hematoma that was probably related to percutaneous access and was successfully managed conservatively. Patient 4 had severe pericardial bleeding followed by ventricular fibrillation, immediately after obtaining percutaneous epicardial access. A lacerated middle cardiac vein was repaired surgically. However, the patient ultimately died of complications. Patient 5 had a history of cardiothoracic surgery and developed a right ventricle-abdominal fistula after multiple attempts at percutaneous access. This was surgically repaired without major sequelae. Patient 6 had cardiac tamponade caused by a lacerated coronary sinus branch during epicardial catheter ablation and required surgical repair. Patient 7 had severe left coronary vasospasm and ventricular fibrillation during catheter manipulation in the pericardium. This complication was successfully managed with intracoronary nitrates.
  
  
  CONCLUSIONS
  Though generally safe, percutaneous epicardial access and mapping/ablation can result in uncommon complications. Awareness of these rare complications may facilitate early detection and successful management.
authors: Helmsley Electrophysiology Center, Mount Sinai Medical Center, New York, NY 10029, USA.
authors: Jacob S
authors: JS
authors: Koruth
authors: Arash
authors: A
authors: Aryana
authors: Srinivas R
authors: SR
authors: Dukkipati
authors: Hui-Nam
authors: HN
authors: Pak
authors: Young-Hoon
authors: YH
authors: Kim
authors: Eduardo A
authors: EA
authors: Sosa
authors: Mauricio
authors: M
authors: Scanavacca
authors: Srijoy
authors: S
authors: Mahapatra
authors: Gorav
authors: G
authors: Ailawadi
authors: Vivek Y
authors: VY
authors: Reddy
authors: Andre
authors: A
authors: d'Avila
mesh_terms: D000293:Adolescent; D000368:Aged; D017541:Aneurysm, False / Q000209:etiology; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002305:Cardiac Tamponade / Q000209:etiology; D017115:Catheter Ablation / Q000009:adverse effects*; D003329:Coronary Vasospasm / Q000209:etiology; D016154:Digestive System Fistula / Q000209:etiology; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D006322:Heart Aneurysm / Q000209:etiology; D006335:Heart Injuries / Q000209:etiology / Q000628:therapy; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008099:Liver / Q000293:injuries; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D019106:Postoperative Hemorrhage / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000209:etiology