Percutaneous epicardial access (Figs. 1A and 1B) has gained wide acceptance as an interventional technique to access the pericardial space. Since its initial description1 in targeting epicardial circuits of ventricular tachycardia (VT) in patients with Chagasic cardiomyopathy, percutaneous epicardial access and ablation has come to play an important role in interventional electrophysiology. This technique has been recognized as a vital addition to catheter ablation of certain cardiac arrhythmias and for the delivery of newer investigational devices such as epicardial suture ligation of the left atrial appendage.
