title: Atypical complications encountered with epicardial electrophysiological procedures.
abstract: BACKGROUND
  With the increasing use, complexity, anatomical approaches, and tools related to epicardial procedures, complications previously not seen during endovascular ablation are now well recognized with epicardial ablation. Whether newer approaches and the regional anatomy of the pericardial space contribute to unexpected complications after epicardial access (EpiAcc) is presently unknown.
  
  
  OBJECTIVE
  To characterize underreported, or novel, complications associated with percutaneous EpiAcc as part of an electrophysiology procedure.
  
  
  METHODS
  We retrospectively reviewed percutaneous EpiAcc as part of an ablation procedure from January 1, 2004, to December 31, 2011.
  
  
  RESULTS
  Of 116 attempts in 107 patients, 8 atypical ablation complications (no procedural deaths) were noted; complications included delayed pericarditis (2 weeks), chronic refractory pericarditis, requirement for snaring of broken intrapericardial wire, pleural perforation, phrenic nerve injury despite protective strategies, hemoperitoneum, and abdominal-pericardial fistula.
  
  
  CONCLUSIONS
  Vigilance both during and after EpiAcc is needed to recognize these complications, some of which may be life-threatening.
authors: Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Ammar M
authors: AM
authors: Killu
authors: Paul A
authors: PA
authors: Friedman
authors: Siva K
authors: SK
authors: Mulpuru
authors: Thomas M
authors: TM
authors: Munger
authors: Douglas L
authors: DL
authors: Packer
authors: Samuel J
authors: SJ
authors: Asirvatham
mesh_terms: D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D004562:Electrocardiography; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
keywords: ARVD; Ablation; Atypical; CS; CT; Complication; Electrophysiology; EpiAcc; Epicardial; Hemoperitoneum; LAA; NSAID; PCIS; PEf; PN; PNI; PVC; Pericardial effusion; Pericarditis; RF; RV; RVOT; Tamponade; VT; Ventricular tachycardia; arrhythmogenic right ventricular dysplasia; computed tomography; conscious sedation; epicardial access; left atrial appendage; nonsteroidal anti-inflammatory drug; pericardial effusion; phrenic nerve; phrenic nerve injury; postcardiac injury syndrome; premature ventricular complex; radiofrequency; right ventricular; right ventricular outflow tract; ventricular tachyarrhythmia