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. 2021 Jan 1;48(1):e207244.
doi: 10.14503/THIJ-20-7244.

Pericardial Access Through the Right Atrium in a Porcine Model

Ishan Kamat  1   2 , William E Cohn  3   2
Affiliations

Pericardial Access Through the Right Atrium in a Porcine Model

Ishan Kamat et al. Tex Heart Inst J. .

Abstract

As procedures such as epicardial ventricular ablation and left atrial appendage occlusion become more commonplace, the need grows for safer techniques to access the physiologic pericardial space. Because this space contains minimal fluid for lubrication, prevailing methods of pericardial access pose considerable periprocedural risk to cardiac structures. Therefore, we devised a novel method of pericardial access in which carbon dioxide (CO2) is insufflated through a right atrial puncture under fluoroscopic guidance, enabling clear visualization of the cardiac silhouette separating from the chest wall. We performed the procedure in 8 Landrace pigs, after which transthoracic percutaneous pericardial access was obtained by conventional means. All of the animals remained hemodynamically stable during the procedure, and none showed evidence of epicardial or coronary injury. The protective layer of CO2 in the pericardial space anterior to the heart facilitated percutaneous access in our porcine model, and the absence of complications supports the potential safety of this method.

Keywords: Arrhythmias, cardiac/surgery; atrial appendage/surgery; minimally invasive surgical procedures/methods; pericardiocentesis/instrumentation/methods; pericardium/surgery.

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Conflict of interest statement

Conflict of interest disclosure(s): Dr. Cohn is a cofounder and shareholder of SentreHeart, Inc.

Figures

Fig. 1
Fig. 1
Fluoroscopic image (anterior view) with radiopaque contrast shows the position of the catheter (arrow) in the right atrium (arrowhead).
Fig. 2
Fig. 2
Fluoroscopic image (lateral view) shows pericardial access obtained with the needle-tipped catheter (arrow) through the right atrial wall.
Fig. 3
Fig. 3
Fluoroscopic image (lateral view) shows pericardial accumulation of CO2 (arrowhead) after insufflation through the needle-tipped catheter (arrow). The cardiac silhouette is easily discernible because of the differing densities and radiopaque properties of CO2 and myocardial tissue.
See this image and copyright information in PMC

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