title: Differences in complication rates between large bore needle and a long micropuncture needle during epicardial access: time to change clinical practice?
abstract: BACKGROUND
  A dry epicardial access (EA) is increasingly used for advanced cardiovascular procedures. Conventionally used large bore needles (Tuohy or Pajunk needle; LBN) have been associated with low but definite incidence of major complications with EA. Use of micropuncture needle (MPN) may decrease the risk of complications. We intended to compare the outcomes of LBN with MPN for EA.
  
  
  RESULTS
  We report a multicenter observational study of consecutive patients who underwent EA for ventricular tachycardia ablation or Lariat procedure using the LBN or MPN. Oral anticoagulation was stopped before the procedure. Baseline characteristics and procedure-related complications were collected and compared. Of the 404 patients, LBN and MPN were used in 46% and 54% of patients, respectively. There was no significant difference in the incidence of inadvertent puncture of myocardium between LBN and MPN (7.6% versus 6.8%, P=0.76). However, there was a significantly higher rate of large pericardial effusions with LBN compared with MPN (8.1% versus 0.9%; P<0.001). The incidence of pleural effusions were not significantly different between both (1.6% versus 2.3%; P=0.64). LBN group had an increase in other complications compared with MPN (open heart surgery to repair cardiac laceration [6 versus 0], injury to liver [1 versus 0], coronaries [1 versus 0], and superior epigastric artery requiring surgical exploration [0 versus 1]).
  
  
  CONCLUSIONS
  The use of MPN is associated with decreased incidence of major complications, and the need for surgical repair and routine use should be considered for EA.
authors.affiliation: From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart Institute, Lincoln (H.N.); Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN (C.E.); Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston (A.R.); Department of Cardiology, Texas Heart Institute, Houston (J.C.); and Department of Cardiology, Jagiellonian University, Krakow, Poland (K.B.).
authors.forename: Sampath
authors.initials: S
authors.lastname: Gunda
authors.affiliation: From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart Institute, Lincoln (H.N.); Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN (C.E.); Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston (A.R.); Department of Cardiology, Texas Heart Institute, Houston (J.C.); and Department of Cardiology, Jagiellonian University, Krakow, Poland (K.B.).
authors.forename: Madhu
authors.initials: M
authors.lastname: Reddy
authors.affiliation: From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart Institute, Lincoln (H.N.); Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN (C.E.); Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston (A.R.); Department of Cardiology, Texas Heart Institute, Houston (J.C.); and Department of Cardiology, Jagiellonian University, Krakow, Poland (K.B.).
authors.forename: Jayasree
authors.initials: J
authors.lastname: Pillarisetti
authors.affiliation: From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart Institute, Lincoln (H.N.); Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN (C.E.); Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston (A.R.); Department of Cardiology, Texas Heart Institute, Houston (J.C.); and Department of Cardiology, Jagiellonian University, Krakow, Poland (K.B.).
authors.forename: Moustapha
authors.initials: M
authors.lastname: Atoui
authors.affiliation: From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart Institute, Lincoln (H.N.); Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN (C.E.); Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston (A.R.); Department of Cardiology, Texas Heart Institute, Houston (J.C.); and Department of Cardiology, Jagiellonian University, Krakow, Poland (K.B.).
authors.forename: Nitish
authors.initials: N
authors.lastname: Badhwar
authors.affiliation: From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart Institute, Lincoln (H.N.); Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN (C.E.); Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston (A.R.); Department of Cardiology, Texas Heart Institute, Houston (J.C.); and Department of Cardiology, Jagiellonian University, Krakow, Poland (K.B.).
authors.forename: Vijay
authors.initials: V
authors.lastname: Swarup
authors.affiliation: From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart Institute, Lincoln (H.N.); Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN (C.E.); Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston (A.R.); Department of Cardiology, Texas Heart Institute, Houston (J.C.); and Department of Cardiology, Jagiellonian University, Krakow, Poland (K.B.).
authors.forename: Luigi
authors.initials: L
authors.lastname: DiBiase
authors.affiliation: From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart Institute, Lincoln (H.N.); Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN (C.E.); Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston (A.R.); Department of Cardiology, Texas Heart Institute, Houston (J.C.); and Department of Cardiology, Jagiellonian University, Krakow, Poland (K.B.).
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Mohanty
authors.affiliation: From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart Institute, Lincoln (H.N.); Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN (C.E.); Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston (A.R.); Department of Cardiology, Texas Heart Institute, Houston (J.C.); and Department of Cardiology, Jagiellonian University, Krakow, Poland (K.B.).
authors.forename: Prashanth
authors.initials: P
authors.lastname: Mohanty
authors.affiliation: From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart Institute, Lincoln (H.N.); Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN (C.E.); Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston (A.R.); Department of Cardiology, Texas Heart Institute, Houston (J.C.); and Department of Cardiology, Jagiellonian University, Krakow, Poland (K.B.).
authors.forename: Hosakote
authors.initials: H
authors.lastname: Nagaraj
authors.affiliation: From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart Institute, Lincoln (H.N.); Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN (C.E.); Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston (A.R.); Department of Cardiology, Texas Heart Institute, Houston (J.C.); and Department of Cardiology, Jagiellonian University, Krakow, Poland (K.B.).
authors.forename: Christopher
authors.initials: C
authors.lastname: Ellis
authors.affiliation: From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart Institute, Lincoln (H.N.); Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN (C.E.); Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston (A.R.); Department of Cardiology, Texas Heart Institute, Houston (J.C.); and Department of Cardiology, Jagiellonian University, Krakow, Poland (K.B.).
authors.forename: Abdi
authors.initials: A
authors.lastname: Rasekh
authors.affiliation: From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart Institute, Lincoln (H.N.); Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN (C.E.); Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston (A.R.); Department of Cardiology, Texas Heart Institute, Houston (J.C.); and Department of Cardiology, Jagiellonian University, Krakow, Poland (K.B.).
authors.forename: Jie
authors.initials: J
authors.lastname: Cheng
authors.affiliation: From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart Institute, Lincoln (H.N.); Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN (C.E.); Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston (A.R.); Department of Cardiology, Texas Heart Institute, Houston (J.C.); and Department of Cardiology, Jagiellonian University, Krakow, Poland (K.B.).
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Bartus
authors.affiliation: From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart Institute, Lincoln (H.N.); Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN (C.E.); Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston (A.R.); Department of Cardiology, Texas Heart Institute, Houston (J.C.); and Department of Cardiology, Jagiellonian University, Krakow, Poland (K.B.).
authors.forename: Randall
authors.initials: R
authors.lastname: Lee
authors.affiliation: From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart Institute, Lincoln (H.N.); Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN (C.E.); Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston (A.R.); Department of Cardiology, Texas Heart Institute, Houston (J.C.); and Department of Cardiology, Jagiellonian University, Krakow, Poland (K.B.).
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.affiliation: From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart Institute, Lincoln (H.N.); Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN (C.E.); Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston (A.R.); Department of Cardiology, Texas Heart Institute, Houston (J.C.); and Department of Cardiology, Jagiellonian University, Krakow, Poland (K.B.). dlakkireddy@gmail.com.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
mesh_terms: D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects* / Q000295:instrumentation; D056149:Epicardial Mapping; D005260:Female; D014943:Global Health; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009339:Needles; D010490:Pericardial Effusion / Q000453:epidemiology / Q000209:etiology*; D011677:Punctures / Q000009:adverse effects / Q000295:instrumentation*; D018570:Risk Assessment; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000601:surgery*
keywords: electrophysiology; needles; pericardial effusion; punctures; tachycardia; ventricular