Hands On
How to perform an epicardial ventricular tachycardia ablation: A contemporary and practical approach
Catheter ablation is increasingly used for the treatment of cardiac arrhythmias. In the 1990s, in order to treat ventricular arrhythmias resulting from chagasic cardiomyopathy, Sosa et al1 developed a technique to enter the pericardium percutaneously in the absence of a pericardial effusion. Since then, “dry” epicardial access has become a regular part of complex catheter ablation. In this review, we concentrate on the technical aspects of performing epicardial ablation for ventricular tachycardia (VT), including the management of potential complications.Management of hemopericardium related to percutaneous epicardial access, mapping, and ablation
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.
