Use of an autologous blood recovery system during emergency pericardiocentesis in the electrophysiology laboratory.

INTRODUCTION: Emergency pericardiocentesis during electrophysiology procedures is often associated with significant aspiration of pericardial blood, requiring transfusion. We sought to assess the feasibility of urgent use of an autologous blood recovery system in the electrophysiology laboratory to autotransfuse blood aspirated from the pericardium. METHODS AND RESULTS: We retrospectively analyzed Mayo Clinic electrophysiology records for patients who had ablation procedure-related pericardial effusions requiring emergency pericardial drainage during an 8-month period. An autologous blood recovery system was used during pericardiocentesis to separate and clean packed red blood cells from the pericardial aspirate. These cells were returned acutely to the patient intravenously. The procedural safety, aspirated and autotransfused volumes, and efficacy of this approach were evaluated. During the study period, nine patients underwent pericardial drainage with autotransfusion using a cell-salvage instrument during electrophysiology procedures. The mean aspirated volume was 1,078 mL, with a mean autotransfused volume of 390 mL. For four patients, all with aspirated volumes of 1,100 mL or less, autotransfusion alone was sufficient to maintain hemodynamic stability and avoid allogeneic transfusion. One patient required surgical intervention because of ongoing pericardial bleeding. The ablation procedure was completed after aspiration in two patients. No procedural complications related to the use of the cell-salvage system occurred. CONCLUSION: Autologous blood recovery during pericardiocentesis is safe, convenient, and feasible. With early use it may decrease or eliminate the need for allogeneic blood transfusion and, in selected cases, may permit completion of the ablation procedure.

Trends in percutaneous pericardial access during catheter ablation of ventricular arrhythmias: a single-center experience.

PURPOSE: Percutaneous pericardial access (EpiAcc) assists ventricular tachycardia/premature ventricular complex (VT/PVC) ablation by permitting epicardial mapping and ablation outside the vicinity of the coronary venous system. We sought to determine whether expanding indications and growing operator experience have led to increased rates of EpiAcc. METHODS: We reviewed the frequency of EpiAcc procedures performed during VT/PVC ablation between 2007 and 2014 to identify temporal trends in the procedure. RESULTS: There were 758 patients undergoing 880 VT/PVC ablation procedures (average 95 patients per year; 110 procedures per year) during the study period. EpiAcc for ablation was utilized in 170 patients (181 procedures). The average age at the time of EpiAcc was 55 ± 16 years and 129 (76.0 %) patients were male. The rate of EpiAcc was 22.9 % in males and 15.4 % in females (P = 0.008). The absolute number of EpiAcc procedures increased from 2007 (6 procedures) to 2014 (27 procedures). Similarly, the proportion of patients undergoing EpiAcc increased from 8.6 % of procedures in 2007 to 24.5 % in 2014 (P < 0.0001). While EpiAcc use became more frequent, the rate of epicardial ablation among those who underwent EpiAcc remained stable (approximately 70 %). CONCLUSIONS: Percutaneous pericardial access has been used with increasing frequency as part of VT/PVC ablations without an increase in the rate of epicardial ablation. This growing utilization may lay the foundation for novel epicardial strategies as new technologies emerge. The frequency of percutaneous pericardial access in VT/PVC ablation appears to be greater in males, reasons for which are undefined.