Feasibility of carbon dioxide insufflation and impact on epicardial approach utilization for ventricular tachycardia ablation in a midvolume referral center

Giulio Zucchelli; Matteo Parollo; Andrea Di Cori; Lorenzo Mazzocchetti; Luca Segreti; Gino Grifoni; Marco Torre; Sara Sbragi; Raffaele De Lucia; Valentina Barletta; Antonio Canu; Stefano Viani; Maria Grazia Bongiorni

doi:10.1016/j.hrthm.2024.02.041

Feasibility of carbon dioxide insufflation and impact on epicardial approach utilization for ventricular tachycardia ablation in a midvolume referral center

Heart Rhythm. 2024 Feb 23:S1547-5271(24)00213-3. doi: 10.1016/j.hrthm.2024.02.041. Online ahead of print.

Affiliations

¹ Second Division of Cardiology, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy. Electronic address: g.zucchelli@ao-pisa.toscana.it.
² Second Division of Cardiology, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy.
³ Second Division of Cardiology, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy; Heart Rhythm Clinic, San Rossore Hospital, Pisa, Italy.

PMID: 38403236
DOI: 10.1016/j.hrthm.2024.02.041

Abstract

Background: Epicardial access is often crucial for successful ventricular tachycardia (VT) ablation, but it is often burdened by significant procedural risk. Intentional coronary vein exit and intrapericardial CO₂ insufflation (EpiCO₂) can facilitate subxiphoid pericardial access.

Objective: This prospective study aimed to assess procedural feasibility, safety, and impact of the introduction of intrapericardial CO₂ insufflation for epicardial access in a referral center for VT ablation.

Methods: All consecutive patients treated with epicardial VT ablation between November 2022 and January 2024 with the EpiCO₂ technique at Pisa University Hospital were prospectively enrolled and compared in terms of feasibility, efficiency, and safety with a local retrospective cohort of patients treated with subxiphoid dry puncture between July 2018 and October 2022.

Results: Twenty-two consecutive patients (90.9% male; mean age, 54.3 years) underwent VT ablation with EpiCO₂ during the study period. Epicardial access was achieved in all patients; median time from coronary sinus (CS) cannulation to epicardial access was 33 minutes. Intentional vein exit was successful in all cases, whereas CO₂ insufflation was not feasible in 1 patient. There were no major complications and no significant bleeding. Since EpiCO₂ introduction, epicardial approach utilization increased from 17.8% to 40% of all VT procedures. Comparison with 20 standard dry approach epicardial ablations showed no significant differences in terms of total procedural duration (322.5 [interquartile range, 296.75-363.75] minutes vs 359 [interquartile range, 323-409] minutes; P = .08).

Conclusion: In our single-center experience, EpiCO₂ was feasible and safe and led to significant increase in procedural volume without affecting total procedural time compared with standard dry puncture.

Keywords: Carbon dioxide; Catheter ablation; Coronary vein; Epicardial access; Ventricular tachycardia.