title: Significance and clinical characteristics of atrial fibrillation post epicardial access.
abstract: BACKGROUND
  Epicardial access (EpiAcc) has become an important adjunct for ventricular tachycardia (VT) or premature ventricular complex (PVC) ablation. We hypothesized that post-procedural pericarditis may lead to an increased risk of atrial fibrillation (AF), and therefore assessed the incidence and clinical impact of post-procedural AF in patients undergoing EpiAcc.
  
  
  METHODS
  We reviewed the records of all patients who underwent EpiAcc as part of an ablation procedure between January 1, 2004 and July 31, 2014 at Mayo Clinic Rochester. AF occurrence was determined by clinical documentation or electrocardiographic recordings post procedure.
  
  
  RESULTS
  Epicardial access was obtained in 170 pts (indication 110 VT and 60 PVC). The mean age was 53 ± 16 years and 122 (72%) were male. Seven (4.1%) patients developed AF within 7 days of the procedure, at a mean of 49 ± 18 h post procedure; it was paroxysmal in all patients with an average duration 6.0 ± 5.5 h (range 2-18). All patients spontaneously converted to sinus rhythm; but 3 needed rate control with AV nodal blockade (calcium channel blockers [n = 2] or beta blockers [n = 1]). One patient out of 60 who received intrapericardial steroids developed AF (2%), while of the 110 who did not receive steroids, 6 developed AF (5%) (p = 0.42). During average follow-up 2.3 years, there were no documented recurrences of atrial fibrillation in these patients.
  
  
  CONCLUSIONS
  Atrial fibrillation following epicardial access is infrequent. When it occurs, it tends to be paroxysmal in nature and without severe symptoms. Administration of intrapericardial steroids did not affect the rate of AF post procedure; further studies however are needed to define their role.
authors.affiliation: Division of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Sugrue
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 1st SW, Rochester, MN, USA. Killu.ammar@mayo.edu.
authors.forename: Ammar M
authors.initials: AM
authors.lastname: Killu
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 1st SW, Rochester, MN, USA.
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 1st SW, Rochester, MN, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: McLeod
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 1st SW, Rochester, MN, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Munger
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 1st SW, Rochester, MN, USA.
authors.forename: Siva K
authors.initials: SK
authors.lastname: Mulpuru
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 1st SW, Rochester, MN, USA.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Packer
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 1st SW, Rochester, MN, USA.
authors.forename: Suraj
authors.initials: S
authors.lastname: Kapa
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 1st SW, Rochester, MN, USA.|Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 1st SW, Rochester, MN, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015984:Causality; D056149:Epicardial Mapping / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D010496:Pericardium / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Atrial fibrillation; Epicardial ablation