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(Circulation. 1999;100:e115.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Different Ways of Aproaching the Normal Pericardial Space

Eduardo Sosa, MD; Mauricio Scanavacca, MD; André d’Avila, MD

Instituto do Coração, University of São Paulo Medical School, São Paulo, Brazil

	Introduction

 
To the Editor:

We have read with great interest the article by Verrier et al¹ on transatrial access to the pericardial space, surely an attractive idea. Exploration of the pericardial space has long been a medical challenge, because it has been suggested that pericardial puncture could only be possible in the presence of a sizable pericardial effusion. However, this concept should no longer be sustained as a definite fact. It is clear from our clinical experience that entering the pericardial space does not require the presence of 200 mL of pericardial fluid, as stated by the authors.

In 1996, our group introduced a novel nonsurgical transthoracic technique to perform epicardial mapping and ablation in the electrophysiology laboratory.^{2 3 4} It consists of the introduction of a regular ablation catheter into the pericardial space by a transthoracic pericardial puncture similar to that described by Krikorian and Hancock.⁵ The main difference is that our patients do not have pericardial effusions.

According to our technique, pericardial puncture is performed via a subxiphoid approach. An epidural needle (Tuohy 17 gauge, effective length 79.4 mm, overall 101.6 mm, OD 1.5 mm; Abbott) used to perform epidural anesthesia is gently advanced under fluoroscopy toward the cardiac silhouette until a slight negative pressure is felt. When the needle tip is inside the pericardial space, contrast medium is injected, which can be seen surrounding the cardiac silhouette, indicating that the needle tip is in the pericardial space. Then, a soft, floppy-tip guidewire is passed through the hollow needle, an 8F . . . [Full Text of this Article]

Richard L. Verrier, PhD; Sergio Waxman, MD; Eric G. Lovett, PhD; Ricardo Moreno, BA

Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Mass