Experimental efficacy of pericardial instillation of anti-inflammatory agents during percutaneous epicardial catheter ablation to prevent postprocedure pericarditis.

Abstract

INTRODUCTION:

Pericarditis is a potential complication of catheter-based percutaneous epicardial mapping and ablation. This study evaluates the efficacy and safety of intrapericardial instillation of anti-inflammatory agents after pericardial mapping and ablation in a porcine model of postprocedural pericarditis.

METHODS AND RESULTS:

Twenty-five healthy swine underwent epicardial mapping and ablation after transthoracic subxyphoid puncture. After 60 minutes of continuous catheter manipulation in the pericardial space, radiofrequency energy was delivered in a linear fashion to the epicardial surfaces of both atria. The animals were randomly divided to receive the anti-inflammatory agents, Hyaluronic Acid and Triamcinolone, or control. Fourteen days after ablation, the hearts were excised and the degree of pericardial reaction/adhesions scored. The severity was uniformly graded 4 (intense) in all control animals and was characterized by intense adhesion between the parietal and the visceral pericardium obscuring tissue planes and epicardial anatomy. Hyaluronic Acid provided a mild benefit (score 3.0 +/- 0.9), but 2 mg/kg of Triamcinolone significantly attenuated the inflammatory effect (all animals uniformly scored 1.0).

CONCLUSION:

In a porcine model of ablation-related pericarditis, intrapericardial instillation of 2 mg/kg of intermediate-acting corticosteroids effectively prevents post-procedure inflammatory adhesion formation.

• Authors: Andre d'Avila, Petr Neuzil, Aravinda Thiagalingam, Paulo Gutierrez, Ryan Aleong, Jeremy N Ruskin, Vivek Y Reddy
• Journal: Journal of cardiovascular electrophysiology (J Cardiovasc Electrophysiol) Vol. 18 Issue 11 Pg. 1178-83 (Nov 2007) ISSN: 1540-8167 [Electronic] United States
• PMID: 17887979 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Inflammatory Agents
• Triamcinolone

Topics

• Animals
• Anti-Inflammatory Agents (administration & dosage)
• Catheter Ablation (adverse effects, methods)
• Disease Models, Animal
• Instillation, Drug
• Pericarditis (etiology, pathology, prevention & control)
• Pericardium
• Swine
• Treatment Outcome
• Triamcinolone (administration & dosage)