Needle-in-needle micropuncture technique for epicardial access during ventricular tachycardia ablation

BACKGROUND: Epicardial access is often required for catheter ablation of ventricular tachycardia (VT) when arrhythmogenic substrates are located on the epicardial surface, but it is associated with potentially serious complications, including cardiac tamponade and coronary artery injury. The use of a needle-in-needle (NiN) micropuncture technique for percutaneous epicardial access may reduce myocardial trauma and improve procedural safety. We aimed to describe a standardized workflow and assess the feasibility and acute safety of epicardial access for VT ablation using a NiN micropuncture technique. METHODS: This retrospective, single-center observational study without a comparator group included 40 consecutive patients who underwent epicardial access for VT ablation using the NiN micropuncture technique between January 2020 and July 2025. Baseline clinical characteristics, procedural details, success of epicardial access, and acute access-related complications were evaluated. RESULTS: Nurse-administered propofol sedation was used in 37 patients (93%). The median total procedure time was 141 min. Epicardial access was successfully achieved in all patients (100%). No major access-related complications occurred, including cardiac tamponade, significant bleeding, or coronary artery injury. One patient developed complete atrioventricular block during epicardial ablation, which was unrelated to the access technique. All patients were discharged without procedure-related disability or death. CONCLUSION: Epicardial access using a NiN micropuncture technique was feasible and acutely safe for VT ablation, achieving a 100% access success rate with no major puncture-related complications.