[Relevant anatomy of epicardial space for the electrophysiologists]

Area of Science:

• Cardiology
• Cardiac Electrophysiology
• Anatomy

Background:

• The arrhythmogenic substrate causing ventricular tachycardia (VT) is often epicardial in conditions like Chagas cardiomyopathy, arrhythmogenic dysplasia, and post-myocarditis.
• Effective substrate-based catheter ablation for VT frequently requires epicardial access.

Purpose of the Study:

• To detail the anatomical considerations for epicardial access during ventricular tachycardia ablation.
• To highlight the importance of understanding epicardial structures for safe and effective procedures.

Main Methods:

• Review of anatomical particularities relevant to epicardial puncture and ablation.
• Discussion of standard anterior percutaneous epicardial puncture techniques.

Main Results:

• The arrhythmogenic substrate is predominantly epicardial in several cardiomyopathies and post-myocardial infarction.
• Key anatomical structures influencing epicardial access include coronary arteries, the phrenic nerve, and epicardial fat.

Conclusions:

• Epicardial access is essential for substrate-based VT ablation in specific patient groups.
• Thorough knowledge of epicardial anatomy is critical for successful and safe epicardial catheter ablation.