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Cardiac Electrophysiology Clinics Sep 2020Percutaneous epicardial access continues to have a growing role within cardiac electrophysiology. The classic approach has typically been with a Tuohy needle via a... (Review)
Review
Percutaneous epicardial access continues to have a growing role within cardiac electrophysiology. The classic approach has typically been with a Tuohy needle via a subxiphoid approach guided by fluoroscopic landmarks and tactile feedback. Recent developments have highlighted the role of the micropuncture needle, electroanatomic mapping, and real-time pressure sensors to reduce complications. Further, different access sites, such as the right atrial appendage, have been described and may offer a novel approach to percutaneous epicardial access. In addition, future directions of percutaneous access may involve direct visualization, near-field impedance monitoring, and real-time virtual imaging.
Topics: Catheter Ablation; Electrophysiologic Techniques, Cardiac; Endovascular Procedures; Heart Diseases; Humans; Pericardium
PubMed: 32771182
DOI: 10.1016/j.ccep.2020.04.004 -
Journal of Medical Imaging and... Nov 2021Echocardiography has long been the mainstay in the evaluation of cardiac and pericardial disease. As computed tomography (CT) has advanced, it has become a valuable... (Review)
Review
Echocardiography has long been the mainstay in the evaluation of cardiac and pericardial disease. As computed tomography (CT) has advanced, it has become a valuable partner in the imaging of the pericardium. The advantages of CT include a larger field of view, multiplanar reconstruction and increased discrimination between various soft tissues and fluids. CT is less operator dependent and can more easily, and reproducibly, image areas of the pericardium for which echocardiography has poor windows such as the right pericardium. The introduction of EKG gating has decreased cardiac motion artifact and can allow functional evaluation although echocardiography remains the primary source of real-time imaging of cardiac and valve motion. It is essential for the skilled cardiac imager to understand the strengths and weaknesses of CT and its role in the definition and assessment of pericardial disease.
Topics: Echocardiography; Heart Diseases; Humans; Magnetic Resonance Imaging; Pericardium; Tomography, X-Ray Computed
PubMed: 34588141
DOI: 10.1016/j.jmir.2021.09.005 -
Radiographics : a Review Publication of... 2019
Review
Topics: Coxsackievirus Infections; Enterovirus B, Human; Female; Heart; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pericarditis; Pericardium
PubMed: 31697617
DOI: 10.1148/rg.2019190081 -
Europace : European Pacing,... Mar 2021We investigated the efficacy of linear multi-electrode irreversible electroporation (IRE) ablation in a porcine model.
AIMS
We investigated the efficacy of linear multi-electrode irreversible electroporation (IRE) ablation in a porcine model.
METHODS AND RESULTS
The study was performed in six pigs (weight 60-75 kg). After median sternotomy and opening of the pericardium, a pericardial cradle was formed and filled with blood. A linear seven polar 7-Fr electrode catheter with 2.5 mm electrodes and 2.5 mm inter-electrode spacing was placed in good contact with epicardial tissue. A single IRE application was delivered using 50 J at one site and 100 J at two other sites, in random sequence, using a standard monophasic defibrillator connected to all seven electrodes connected in parallel. The pericardium and thorax were closed and after 3 weeks survival animals were euthanized. A total of 82 histological sections from all 18 electroporation lesions were analysed. A total of seven 50 J and fourteen 100 J epicardial IRE applications were performed. Mean peak voltages at 50 and 100 J were 1079.2 V ± 81.1 and 1609.5 V ± 56.8, with a mean peak current of 15.4 A ± 2.3 and 20.2 A ± 1.7, respectively. Median depth of the 50 and 100 J lesions were 3.2 mm [interquartile range (IQR) 3.1-3.6] and 5.5 mm (IQR 4.6-6.6) (P < 0.001), respectively. Median lesion width of the 50 and 100 J lesions was 3.9 mm (IQR 3.7-4.8) and 5.4 mm (IQR 5.0-6.3), respectively (P < 0.001). Longitudinal sections showed continuous lesions for 100 J applications.
CONCLUSION
Epicardial multi-electrode linear application of IRE pulses is effective in creating continuous deep lesions.
Topics: Animals; Catheter Ablation; Catheters; Electrodes; Electroporation; Pericardium; Swine
PubMed: 33200191
DOI: 10.1093/europace/euaa280 -
Current Cardiology Reports Jul 2021Tumors of the pericardium are rare, but a wide variety of congenital, infectious, inflammatory, and neoplastic processes have been reported. Pericardial tumors can be... (Review)
Review
PURPOSE OF REVIEW
Tumors of the pericardium are rare, but a wide variety of congenital, infectious, inflammatory, and neoplastic processes have been reported. Pericardial tumors can be categorized as non-neoplastic or neoplastic. Neoplastic lesions can be further divided into benign or malignant, with malignancies being either primary or secondary (metastatic). Clinical, radiographic, and pathologic features of the most common entities are discussed.
RECENT FINDINGS
Metastatic neoplasms involving the heart and pericardium are far more common than primary pericardial neoplasms. Of primary pericardial malignancies, mesothelioma is the most common; notably, cytology of effusion fluid is relatively insensitive to the diagnosis. The prognosis for most malignancies of the pericardium, primary or secondary, is poor. Increasingly, clinically recognized diseases that involve the pericardium include Erdheim-Chester and IgG4-related disease. This article provides a comprehensive review of the most recent literature to develop a structured framework to the differential diagnosis of pericardial tumors.
Topics: Diagnosis, Differential; Heart Neoplasms; Humans; Mesothelioma; Mesothelioma, Malignant; Pericardium
PubMed: 34269901
DOI: 10.1007/s11886-021-01548-6 -
JACC. Cardiovascular Imaging Jun 2020Frequently, multimodality imaging is indispensable in the care of patients with pericardial disease. With cardiac magnetic resonance imaging, pericardial inflammation... (Review)
Review
Frequently, multimodality imaging is indispensable in the care of patients with pericardial disease. With cardiac magnetic resonance imaging, pericardial inflammation can be characterized as acute, subacute, or chronic. This spectrum of inflammation is variably associated with reduced compliance of the pericardium, which may result in constrictive pathophysiology, typically well-defined with echocardiography. This interplay between inflammation and hemodynamics is often optimally characterized with multimodality imaging and has redefined the approach of pericardiologists to diagnose, prognosticate, and tailor individual therapies.
Topics: Acute Disease; Asymptomatic Diseases; Cardiac Imaging Techniques; Chronic Disease; Clinical Decision-Making; Hemodynamics; Humans; Multimodal Imaging; Pericarditis; Pericardium; Predictive Value of Tests
PubMed: 31734199
DOI: 10.1016/j.jcmg.2019.08.027 -
Journal of Basic and Clinical... Nov 2022A variety of fat compartments have several local and systemic effect and play a crucial role in the maintenance of health and development of disease. For the past few... (Review)
Review
A variety of fat compartments have several local and systemic effect and play a crucial role in the maintenance of health and development of disease. For the past few years, special attention has been paid to epicardial fat. It is the visceral fat compartment of the heart and has several local and systemic effects. It can perform a role in the development of cardiometabolic risk. The epicardial adipose tissue (EAT) is a unique and multifunctional fat compartment of the heart. It is located between the myocardium and the visceral pericardium. During normal physiological conditions, the EAT has metabolic, thermogenic, and mechanical (cardioprotective) characteristics. The EAT can produce several adipocytokines and chemokines depending on microenvironments. It can influence through paracrine and vasocrine mechanism and participate in the development and progression of cardiovascular (CVS) diseases. In addition, metabolic disease leads to changes in both thickness and volume of the EAT, and it can modify the structure and the function of heart. It has been associated with various CVS diseases such as, cardiomyopathy, atrial fibrillation, and coronary artery disease. Therefore, EAT is a potential therapeutic target for CVS risk.
Topics: Humans; Cardiovascular Diseases; Risk Factors; Pericardium; Adipose Tissue; Heart Disease Risk Factors
PubMed: 36220013
DOI: 10.1515/jbcpp-2022-0230 -
Circulation Journal : Official Journal... Apr 2020
Topics: Adipose Tissue; Cadaver; Humans; Inflammation; Pericardium; Plaque, Atherosclerotic; Vasa Vasorum
PubMed: 32281580
DOI: 10.1253/circj.CJ-20-0249 -
Heart (British Cardiac Society) Feb 2024
Topics: Humans; Heart Atria; Echocardiography; Pericardium; Adipose Tissue
PubMed: 38395440
DOI: 10.1136/heartjnl-2023-323588 -
Cardiac Electrophysiology Clinics Sep 2020The intracoronary artery and venous routes provide unique roadmaps for mapping and interventions for ventricular arrhythmias and certain atrial arrhythmias. The unique... (Review)
Review
The intracoronary artery and venous routes provide unique roadmaps for mapping and interventions for ventricular arrhythmias and certain atrial arrhythmias. The unique anatomic location of these vessels on the epicardial surface enables mapping/interventions without the need to access the pericardial space. These anatomic routes also track deep into certain intramural regions, with interventions that are not accessible from either epicardial or endocardial routes. To map smaller vessels, multipolar catheters and wires are used to record local electrograms. Endocardial/epicardial ablation at adjacent sites is sometimes required to enhance successful outcomes. This article describes tools, techniques, and site-specific mapping and interventions.
Topics: Arrhythmias, Cardiac; Catheter Ablation; Coronary Vessels; Epicardial Mapping; Humans; Pericardium
PubMed: 32771192
DOI: 10.1016/j.ccep.2020.06.006