Access routes,devices and guidance methods for intrapericardial delivery in cardiac conditions |
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| Affiliation: | 1. UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK;2. Centre for Precision Healthcare, UCL Division of Medicine, University College London, 5 University Street, London WC1E 6JF, UK;1. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada;2. Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany;3. Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany;4. Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 1P8, Canada;5. Faculty of Medicine, Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King''s College Circle, Room 2374, Toronto, Ontario, M5S 1A8, Canada;6. Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S 3M1, Canada;7. Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, M5T 1R8, Canada;8. I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Street 8, b. 2, Moscow, 119991, Russian Federation;1. Department of Pathology and Laboratory Medicine, British Columbia Children''s Hospital, Vancouver, BC, Canada;2. British Columbia Children''s Hospital Research Institute, Vancouver, BC, Canada;3. Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada;1. Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Torino, Italy, Corso Bramante 88/90, 10126 Turin, Italy;1. Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt, Germany;2. German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany;3. Frankfurt Cancer Institute, Frankfurt, Germany;4. Excellence Cluster Cardio-Pulmonary Institute, Frankfurt, Germany;1. Cardiorenal Translational Laboratory, Institute of Research i+12 and Hypertension Unit, Hospital Universitario 12 de Octubre, Madrid, Spain;2. CIBER in Cardiovascular (CIBERCV), Hospital Universitario 12 de Octubre, Madrid, Spain;3. School of Doctoral Studies and Research, Universidad Europea, Madrid, Spain;4. Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Instituto De Investigación Sanitaria Gregorio Marañón, Madrid, Spain |
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| Abstract: | Drug deposition into the intrapericardial space is favourable for achieving localised effects and targeted cardiac delivery owing to its proximity to the myocardium as well as facilitating optimised pharmacokinetic profiles and a reduction in systemic side effects. Access to the pericardium requires invasive procedures but the risks associated with this have been reduced with technological advances, such as combining transatrial and subxiphoid access with different guidance methods. A variety of introducer devices, ranging from needles to loop-catheters, have also been developed and validated in pre-clinical studies investigating intrapericardial delivery of therapeutic agents. Access techniques are generally well-tolerated, self-limiting and safe, although some rare complications associated with certain approaches have been reported. This review covers these access techniques and how they have been applied to the delivery of drugs, cells, and biologicals, demonstrating the potential of intrapericardial delivery for treatments in cardiac arrhythmia, vascular damage, and myocardial infarction. |
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