Introduction: Percutaneous catheter ablation for ventricular tachycardias (VT) is an established way of treating symptomatic. Endocardial approach to ablation is often not sufficient to gain full control of arrhythmia since substrate is contained closer to epicardial myocardium layer. This is especially true for the patients with the non-ischemic cardiomyopathy (NICM). It is for this subset of patients that percutaneous, subxiphoid, epicardial approach for ventricular tachycardia ablation should be utilized (1).

Patients and Methods: This is a case series presentation with an overview of indications and some intraprocedural aspects of epicardial VT ablation procedures performed from December 2017 to November 2018 in 5 patients in whom we used this approach at University Hospital Centre Split.

Results: All the patients had diagnosis of NICM (3 dilated cardiomyopathy, 2 post myocarditis). Mean patient age was 57 years (range 27-71), all males. Procedures were done in general anesthesia. The puncture of pericardial space was obtained under an X ray guidance using standardized views and protocol. In 3, epicardial approach was utilized because of the history of previous failed endocardial ablation, while in the rest imaging data pointed toward epicardial substrate (MRI or echocardiography data). All the ablations were done with help of the 3D mapping system, using dedicated, steerable sheath for epicardial approach and contact force sensing catheters. Mean procedure time was 279±33 minutes. No radiofrequency application was applied epicardialy in one patient since the electroanatomical data show no clear arrhythmia substrate. In the rest, combined endo and epi approaches were utilized to gain VT noninducibility at the end of procedures with aggressive stimulation protocol with up to 4 extrastimuli. No complications occurred during any of these epicardial VT cases and all the patients were discharged 2 days after the procedure.

Conclusion: Epicardial VT ablation is highly invasive procedure with substantial list of serious complications, but when done in institutions with cardiac surgery back-up and high-volume cardiac electrophysiology team holds a promise to gain a control over VT recurrency and prolong patients’ life.