Percutaneous Approach to Pericardial Disease Management

Percutaneous access of the pericardial space is increasingly sought. This is not only due to growing prevalence of pericardial effusions and cardiac tamponade, but also the emerging diagnostic and therapeutic potential of the pericardial space for mapping and ablation of arrhythmogenic circuits, biopsy, and drug delivery. Although increasingly performed, percutaneous pericardiocentesis remains a technically challenging procedure with potentially life-threatening complications. Consequently, management of patients with pericardial disease is highly complex. In this chapter we outline a step-by-step approach to percutaneous pericardiocentesis and the required specialised management of pericardial disease patients. Procedural complications are discussed along with their alleviating therapeutic strategies. Furthermore, we describe approaches to the prevention and management of recurrent pericardial effusion including diagnostic and therapeutic procedures such as percutaneous balloon pericardiotomy and intra-pericardial delivery of chemotherapeutics and sclerosing agents.