Epicardial Ablation of Idiopathic Ventricular Tachycardia

Epicardial ventricular tachycardia (VT) is an increasingly recognized arrhythmia in clinical practice. Electrocardiographic algorithms to identify epicardial VT should be used with the understanding that they are an initial guide to localization and do not exclude an epicardial origin of VT, particularly when endocardial approaches are unsuccessful. Ablation using a transvenous approach or direct epicardial access may produce favorable results, although care must be taken to avoid coronary artery or phrenic nerve injury. A subset of patients require a combined endocardial and epicardial approach to eliminate VT. Although these ablation strategies are generally well tolerated, they should be limited to patients with highly symptomatic arrhythmias or those in whom myocardial depression is thought to be related to prolonged tachycardia or repetitive ventricular ectopy.