Non-contrast left lateral view X-ray guided pericardial puncture

Objective To explore the effectiveness and safety of non-contrast left lateral view X-ray guided pericardial puncture. Methods We recruited 52 patients with cardiac infarction, arrhythmogenic right ventricular dysplasia, dilated cardiomyopathy, hypertrophy cardiomyopathy and some epicardial premature ventricular contraction or pericardial ventricular tachycardia. The puncture needle was located on the middle between the apex and the bottom of the heart in the 30-degree RAO fluoroscopic view. A dry intrapericardial access was obtained under the left-costal-angle. The puncture needle, containing a 145-cm-long guide wire inside the tip of the needle, was advanced into the, trigonometric gap which was among the diaphragm, xiphoid and anterior right ventricular chamber, under fluoroscopic guidance. The needle was continuously pushed toward the posterior until the heartbeat or drop off could be felt. The wire reached the pericardial cavity was confirmed if there was no resistance while sending out the guide wire. The guide wire was further sent out to confirm the presence of a circle around the heart, which was the evidence of successful pericardial puncture. Results Among the 52 patients, 36 male and 16 female patients, aged 46±13 years with body mass index (24.59±2.56) kg/m2, 3 patients were diagnosed with dilated cardiomyopathy, 20 suffered from ischemic cardiomyopathy, 6 had arrhythmogenic right ventricular cardiomyopathies, 7 had hypertrophic cardiomyopathy and 16 had idiopathic or premature ventricular tachycardia. The pericardial punctures were done success at the first attempt in 46 patients, while more than one attempt was required in 5 patients. Mapping and ablation were completed in 51 out of 52. The whole procedure took about 10±1.3 minutes and 5±3.2 minutes X-fluoroscopy. Venipuncture needle was suitable for 47 patients, while Tuohy puncture needle was needed for the other 5 patients. Complications were observed in 8 patients: 1 case of acute pericardial tamponade due to injury of the coronary artery who received emergency operation and recovered; 3 patients with right ventricular injuries without adverse results; 2 patients with pleural cavities injuries without adverse results; 1 patient with severe pain around the puncture that was relieved with medication; and 1 with fever that was relieved by treatment. Conclusion Non-contrast left lateral view X-ray guided pericardial puncture is safe and feasible for epicardial mapping and ablation and can decrease the incidence of complications. Key words: Pericardial puncture; Left lateral position; Non-contrast