Percutaneous epicardial radiofrequency ablation of idiopathic ventricular tachycardia

We describe 3 patients with ventricular tachycardia in whom epicardial ablation was done after prior attempts of endocardial ablation had failed. Clinical ventricular tachycardia originated at the right ventricular outflow tract in one patient and near the mitral annulus in another patient. In these two cases ventricular tachycardia was mapped and successfully ablated with a percutaneous subxiphoid approach to the pericardial space. In the remaining patient, ventricular tachycardia. originated near the mitral annulus and was ablated via a coronary vein. The two patients who presented tachycardiomopathy recovered normal left ventricular function after successful ablation. Failure of endcardial ablation may reflect a substrate of epicardial arrhythmia. Epicardial ablation is effective and provides an alternative therapy for patients with ventricular tachycardia, including those with no structural heart disease.