Background and Aims Pericardiocentesis is usually completed under fluoroscopy. The electroanatomic mapping (EAM) system allows visualizing puncture needle tip (NT) while displaying the electrogram recorded from NT, making it possible to obtain epicardial access (EA) independent of fluoroscopy. This study was designed to establish and validate a technique by which EA is obtained under guidance of 3-dimensional (3D) EAM combined with NT electrogram. Methods 3D shell of the heart was generated and the NT was made trackable in the EAM system. Unipolar NT electrogram was continuously monitored. Penetration into pericardial sac was determined by an increase in NT potential amplitude and an injury current. A long guidewire of which the tip was also visible in the EAM system was advanced to confirm EA. Results EA was successfully obtained without complication in 13 pigs and 22 patients. In the animals, NT potential amplitude was 3.2± 1.0 mV when it was located in mediastinum, 5.2±1.6 mV when in contact with fibrous pericardium and 9.8±2.8 mV after penetrating into pericardial sac (all p≤0.001). In human subjects, it measured 1.54±0.40 mV, 3.61±1.08 mV and 7.15±2.88 mV respectively (all p<0.001). Fluoroscopy time decreased in every 4-5 cases (64±15, 23±17 and 0 second for animals 1-4, 5-8, 9-13 respectively, p=0.01; 44±23, 31±18; 4±7 seconds for patients 1-7, 8-14, 15-22 respectively, p<0.001). In 5 pigs and 7 patients, EA was obtained without X-ray exposure. Conclusions By tracking NT in the 3D EAM system and continuously monitoring the NT electrogram, it is feasible and safe to obtain EA with minimum or no fluoroscopic guidance.

中文翻译：

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使用三维电解剖测绘进行心外膜通路：针追踪、电图特征和临床应用

背景和目的 心包穿刺术通常在透视下完成。电解剖图 (EAM) 系统允许可视化穿刺针尖 (NT)，同时显示 NT 记录的电描记图，从而可以独立于透视检查获得心外膜通路 (EA)。本研究旨在建立并验证一种在 3 维 (3D) EAM 结合 NT 电图指导下获得 EA 的技术。方法 生成心脏的 3D 外壳，并使 NT 在 EAM 系统中可追踪。连续监测单极 NT 电图。通过 NT 电位幅度和损伤电流的增加来确定对心包囊的渗透。推进一根长导丝，其尖端在 EAM 系统中也可见，以确认 EA。结果 13头猪和22名患者均成功获得EA，无并发症。在动物中，NT电位幅值位于纵隔时为3.2±1.0 mV，接触纤维心包时为5.2±1.6 mV，穿入心包囊后为9.8±2.8 mV（均p≤0.001）。在人类受试者中，其测量值分别为 1.54±0.40 mV、3.61±1.08 mV 和 7.15±2.88 mV（全部 p<0.001）。每 4-5 例中透视时间减少（动物 1-4、5-8、9-13 分别为 64±15、23±17 和 0 秒，p=0.01；44±23、31±18；4±7）患者1-7、8-14、15-22分别为秒，p＜0.001)。在 5 头猪和 7 名患者中，无需 X 射线照射即可获得 EA。结论 通过在 3D EAM 系统中跟踪 NT 并持续监测 NT 电图，在最少或无需透视引导的情况下获得 EA 是可行且安全的。