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RF ablation parameters used in the pericardium differed depending on the type of catheter and the center. After 2006, externally irrigated�Ctip catheters (3.5-mm tip, ThermoCool, NaviStar or not; Biosense Webster, Diamond Bar, California) were used at all 3 centers for epicardial RF ablation. Catheter irrigation during epicardial mapping was set at 0 or 1 ml/min. During epicardial ablation, power ranged from 20 to 50 W, with irrigation of 10 to 30 ml/min. Intrapericardial fluid was drained selleck products by aspiration from the access sheath periodically after RF ablation lesions or continuously with a vacuum system connected to the epicardial sheath, which was 0.5- to 1-F larger than the ablation catheter. Before ablation on the left ventricular epicardium, coronary angiography was performed to confirm the absence of a coronary artery at the ablation site. High-output (10 mA or greater) pacing was also performed before ablation on the lateral left ventricular wall to exclude close proximity to the left phrenic nerve FMO4 (12). From pericardial access to pericardial sheath removal, a catheter or a guidewire was always present, protruding from the sheath, because of concern that the sharp edge of a pericardial sheath might predispose to laceration of adjacent tissue or vessels. The pericardial sheath was removed at the end of the ablation in the absence of pericardial bleeding. Echocardiography was performed within 24 h after the procedure and/or at discharge to assess pericardial fluid. Use of nonsteroidal anti-inflammatory drugs was left to the physician's discretion. Data were collected from a centralized system containing complete records of all patients treated and followed at the different centers. These records provided detailed histories and diagnoses for all patients, ablation reports, emergency department visits and outpatient visits, as well as data recorded during inpatient care. Patients local to the hospital were followed up in the ablation center. For the other patients, referring cardiologists were contacted for clinical http://www.selleckchem.com/products/ve-822.html follow-up and echocardiographic data of their patients. Mortality was assessed from the Social Security Death Index for American patients or by direct phone calls to referring physicians for European patients. Continuous variables are expressed as mean �� SD or medians when indicated. Complication and right ventricular (RV) puncture rates of the first 78 procedures compared with the following 78 were compared using Fisher exact tests. A p value