Subxyphoid pericardial ablation has a low probability of success in patients with idiopathic epicardial VAs due to the proximity of the site of origin to coronary arteries.
May favor CVS over pericardial access for epicardial idiopathic VA ablation; leaves open prospective outcome trials.
The CVS is closer to the SOO of epicardial idiopathic VAs than the pericardial space, the ventricular endocardium, and the aortic cusps. Given the proximity to coronary arteries at the SOO, radiofrequency energy often cannot be safely delivered to eliminate a VA and ablation may also need to be performed from adjacent structures. A subxyphoid pericardial ablation procedure has a low probability of success in patients with idiopathic epicardial VAs.
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Carrigan et al. (2014) studied this question.
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