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Korean Circ J. 2018 Sep;48(9):778-791. English. Review.
Cardoso R , Aryana A , Singh SM , Tandri H , d'Avila A .
Center of Excellence for ARVC and Complex Ventricular Arrhythmias, Johns Hopkins University, Baltimore, MD, USA.
Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, CA, USA.
Schulich Heart Program, Sunnybrook Health Sciences Centre, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Hospital Cardiológico SOS Cardio - Florianópolis, Florianópolis, SC, Brazil.

For over 3 decades, it has been known that reentry circuits for ventricular tachycardia (VT) are not limited to the subendocardial myocardium. Rather, intramural or subepicardial substrates may also give rise to VT, particularly in those with non-ischemic cardiomyopathy. Percutaneous epicardial mapping and ablation has been successfully introduced for the treatment of such subepicardial VT. Herein, we review the indications for epicardial ablation and the identification of epicardial VT by electrocardiographic and imaging modalities. We also discuss the optimal technique for epicardial access and the implications of epicardial fat which has the potential to mimic scar, decreasing the specificity of electrogram morphology and impeding energy delivery to the tissue. Finally, we also report on possible complications of the procedure and strategies to mitigate adverse events.

Copyright © 2019. Korean Association of Medical Journal Editors.