Epicardial access: Adjusting the approach as we discover complications

Abstract

Perhaps as no other sub-specialty field in cardiology, electrophysiologists have had to rediscover the underlying anatomy at a highly nuanced and sophisticated level primarily to avoid procedural complications. For example, classical anatomy did not pay significant attention to sub-Eustachian pouches, traversing pectinates, or exact relationships with the cavotricuspid isthmus and the right coronary artery until failed flutter ablations or vascular injury had been reported. Such rediscovered anatomy has led to iterative adjustments in navigation and ablation approaches with a variety of arrhythmias. This article is protected by copyright. All rights reserved.