Application Progress of Epicardial Approach in Cardiac Electrophysiology
Successfully entering the epicardial space is the basis of many cardiac operations.During catheter ablation of ventricular arrhythmias and epicardial accessory pathway especially in matrix ablation of epicardial ventricular tachycardia in non-ischemic cardiomyopathy,percutaneous subxiphoid epicardial approach has become the preferred treatment strategy for these ventricular arrhythmias.With the deepening of research,percutaneous subxiphoid epicardial approach has been gradually applied to left atrial appendage occlusion,esophageal protection,phrenic nerve protection,mapping and ablation of atrial fibrillation,epicardial pacing lead implantation.Safe access to the epicardial space is a major challenge.In the past few years,advances of various technologies,such as needle-in-needle technique,carbon dioxide perfusion through the coronary sinus or right atrial appendage,dry pericardiocentesis without contrast media and epicardial puncture needle for real-time pressure/frequency monitoring have significantly improved the safety of epicardial approach.Based on this,this paper mainly reviews the pericardial structure,the indications of epicardial surgery and the influence of common epicardial approach on patients,in order to provide reference for future research.
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