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Percutaneous pericardial access for electrophysiological studies in patients with prior cardiac surgery: approach and understanding the risks.

INTRODUCTION: The number of procedures for which percutaneous pericardial access is used for has gradually increased since its initial description, and now includes mapping/ablation, atrial appendage ligation and pericardial biopsy. Areas covered: Successful percutaneous pericardial access is predicated on having a thorough understanding of regional anatomy, indications for attempting pericardial puncture and potential complications with appropriate management which are highlighted in this review. In addition, we will discuss the access technique itself, provide tips and pitfalls and highlight future directions with an emphasis on patients with prior cardiac surgery. Expert commentary: Percutaneous epicardial access, especially in patients with prior cardiac surgery, is associated with significant complications and therefore meticulous preparation is required. Even in experienced centers, unusual circumstances may be crossed.

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