Patient Selection, Techniques, and Complication Mitigation for Epicardial Ventricular Tachycardia Ablation

Card Electrophysiol Clin. 2022 Dec;14(4):657-677. doi: 10.1016/j.ccep.2022.07.007.


Percutaneous epicardial ventricular tachycardia ablation can decrease implanted cardioverter defibrillator shocks and hospitalizations; proper patient selection and procedural technique are imperative to maximize the benefit-risk ratio. The best candidates for epicardial ventricular tachycardia will depend on history of prior ablation, type of cardiomyopathy, and specific electrocardiogram and cardiac imaging findings. Complications include hemopericardium, hemoperitoneum, coronary vessel injury, and phrenic nerve injury. Modern epicardial mapping techniques provide new understandings of the 3-dimensional nature of reentrant ventricular tachycardia circuits across cardiomyopathy etiologies. Where epicardial access is not feasible, alternative techniques to reach epicardial ventricular tachycardia sources may be necessary.

Keywords: Epicardial access; Radiofrequency ablation; Ventricular tachycardia.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Arrhythmias, Cardiac / complications
  • Cardiomyopathies* / complications
  • Epicardial Mapping / adverse effects
  • Humans
  • Patient Selection
  • Tachycardia, Ventricular*
  • Treatment Outcome