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Peer-reviewedCC BY-NC-NDJACC. Asia

Multicenter Coronary Venous Carbon Dioxide Insufflation for Subxiphoid Epicardial Access in Ventricular Tachycardia Ablation.

  • Kennosuke Yamashita1
  • Keita Yoshiyama2
  • Yuhei Kasai3
  • Takayuki Kitai4
  • Koji Higuchi5
  • Yohei Kikuchi2
  • Daiki Kumazawa2
  • Yosuke Mizuno2
  • Kosuke Onodera2
  • Akira Mizukami6
6 affiliations
  1. 1Heart Rhythm Center, Department of Cardiovascular Medicine, Sendai Kosei Hospital, Sendai, Miyagi, Japan. Electronic address: [email protected].
  2. 2Heart Rhythm Center, Department of Cardiovascular Medicine, Sendai Kosei Hospital, Sendai, Miyagi, Japan.
  3. 3Department of Cardiology, Sapporo Heart Center, Sapporo, Hokkaido, Japan. Electronic address: https://twitter.com/yuheyheyheyhey.
  4. 4Department of Cardiology, Sapporo Heart Center, Sapporo, Hokkaido, Japan. Electronic address: https://twitter.com/EPsamurai1982.
  5. 5Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
  6. 6Department of Cardiology, Kameda Medical Center, Kamogawa, Chiba, Japan. Electronic address: https://twitter.com/akmizukami.
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Abstract

Percutaneous subxiphoid epicardial access for ventricular tachycardia ablation carries a substantial risk of catastrophic complications. Intentional coronary venous carbon dioxide insufflation (Epi-CO₂) creates a radiolucent pneumopericardium that provides a broad needle target, but evidence is dominated by single-center reports. We retrospectively analyzed 53 consecutive patients undergoing epicardial access for ventricular tachycardia ablation at 3 Japanese tertiary centers (Epi-CO₂, n = 28; conventional access, n = 25). Major access-related complications occurred in 0 of 28 Epi-CO₂ patients vs 3 of 25 (12.0%) conventional-access patients, including ventricular puncture, tamponade, and 2 in-hospital deaths, without prolonging total procedure time (270 vs 301 minutes; P = 0.142). Core Epi-CO₂ metrics, including CO₂ volume and epicardial-access fluoroscopy time, were consistent across all 3 centers, and all 6 high-risk patients underwent the procedure without complication. In this first Asian multicenter experience, Epi-CO₂ was associated with the absence of major access-related complications, including in anatomically challenging cases.

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Cite

BibTeXRIS
BibTeX
@article{yamashita2026multicenter,
  title = {{Multicenter Coronary Venous Carbon Dioxide Insufflation for Subxiphoid Epicardial Access in Ventricular Tachycardia Ablation.}},
  author = {Kennosuke Yamashita and Keita Yoshiyama and Yuhei Kasai and Takayuki Kitai and Koji Higuchi and Yohei Kikuchi and Daiki Kumazawa and Yosuke Mizuno and Kosuke Onodera and Akira Mizukami},
  journal = {JACC. Asia},
  year = {2026},
  month = oct,
  doi = {10.1016/j.jacasi.2026.08.017},
  url = {https://europepmc.org/article/MED/42841572},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Multicenter Coronary Venous Carbon Dioxide Insufflation for Subxiphoid Epicardial Access in Ventricular Tachycardia Ablation.
AU  - Kennosuke Yamashita
AU  - Keita Yoshiyama
AU  - Yuhei Kasai
AU  - Takayuki Kitai
AU  - Koji Higuchi
AU  - Yohei Kikuchi
AU  - Daiki Kumazawa
AU  - Yosuke Mizuno
AU  - Kosuke Onodera
AU  - Akira Mizukami
PY  - 2026
DA  - 2026/10/01
JO  - JACC. Asia
DO  - 10.1016/j.jacasi.2026.08.017
UR  - https://europepmc.org/article/MED/42841572
AB  - Percutaneous subxiphoid epicardial access for ventricular tachycardia ablation carries a substantial risk of catastrophic complications. Intentional coronary venous carbon dioxide insufflation (Epi-CO₂) creates a radiolucent pneumopericardium that provides a broad needle target, but evidence is dominated by single-center reports. We retrospectively analyzed 53 consecutive patients undergoing epicardial access for ventricular tachycardia ablation at 3 Japanese tertiary centers (Epi-CO₂, n = 28; conventional access, n = 25). Major access-related complications occurred in 0 of 28 Epi-CO₂ patients vs 3 of 25 (12.0%) conventional-access patients, including ventricular puncture, tamponade, and 2 in-hospital deaths, without prolonging total procedure time (270 vs 301 minutes; P = 0.142). Core Epi-CO₂ metrics, including CO₂ volume and epicardial-access fluoroscopy time, were consistent across all 3 centers, and all 6 high-risk patients underwent the procedure without complication. In this first Asian multicenter experience, Epi-CO₂ was associated with the absence of major access-related complications, including in anatomically challenging cases.
SN  - 2772-3747
ER  -