Epicardial access complications during electrophysiology procedures

Jorge Romero, Kavisha Patel, Dhanunjaya Lakkireddy, Isabella Alviz, Alejandro Velasco, Daniel Rodriguez, Joseph Karpenos, Xiao Dong Zhang, Andrea Natale, Luigi Di Biase

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations


Introduction: Percutaneous epicardial access (EA) was first described more than two decades ago. Since its initial introduction, indications for its utilization in the field of electrophysiology have expanded dramatically. Discussion: Epicardial mapping and ablation in patients with ventricular tachycardia is routinely performed in tertiary electrophysiology centers around the world. Although limited by lack of randomized controlled trials, epicardial ablation for atrial fibrillation has been suggested as a conjunctive strategy in patients who have failed an initial endocardial catheter ablation attempt, and it is necessary for placement of some left atrial appendage occlusion devices as well. An accurate understanding of the cardiac anatomy is crucial to avoid complications such as inadvertent right ventricular puncture, injury to the coronary arteries, abdominal viscera, phrenic nerves, and esophagus during both EA and catheter ablation. Conclusion: The aim of this review is to provide a comprehensive overview of the cardiac anatomy, technical aspects to optimize the safety of epicardial puncture, recognize and avoid potential complications.

Original languageEnglish (US)
Pages (from-to)1985-1994
Number of pages10
JournalJournal of cardiovascular electrophysiology
Issue number7
StatePublished - Jul 2021


  • epicardial ablation
  • epicardial access
  • pericardial bleeding
  • phrenic nerve protection and esophageal protection
  • right ventricular perforation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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