Safety of epicardial access for ventricular tachycardia ablation using a micropuncture needle

Background Epicardial access is often required for catheter ablation of ventricular tachycardia (VT) when arrhythmogenic substrates are located on the epicardial surface, but it carries a risk of serious complications such as cardiac tamponade and coronary artery injury. A refined technique using a small-caliber micropuncture needle (21-gauge) for percutaneous epicardial puncture may enhance safety by minimizing myocardial trauma. Objective To evaluate the acute procedural safety and feasibility of epicardial access for VT ablation using a 21-gauge micropuncture needle. Methods We retrospectively analyzed 40 consecutive patients who underwent epicardial approach during VT ablation using a 21-gauge micropuncture needle between January 2020 and July 2025. Baseline patient characteristics were collected. Procedural details, acute success of epicardial access, and complications during or immediately after the procedure were evaluated. Results The mean age was 59 ± 13 years, 8 patients (20%) were female, and 15 patients (38%) had ischemic cardiomyopathy. Epicardial access was successfully achieved in all patients. The mean total procedure time was 210 ± 60 minutes (Table A). No major access-related complications occurred, including cardiac tamponade, significant bleeding, or coronary artery injury (Table B). Conclusions The use of a 21-gauge micropuncture needle for epicardial access demonstrated feasibility and acute safety for VT ablation, with a 100% access success rate and no access-related major complications. This technique shows promise as a safer alternative to conventional large-bore epicardial needles, though further comparative studies and long-term follow-up data are needed to confirm its benefits.