Needle-in-needle micropuncture epicardial access: minimizing needle size to maximize safety?

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Ventricular tachycardia requiring epicardial access for ablation (n=40). Intervention: Needle-in-needle (NIN) micropuncture technique. Primary outcome: Successful epicardial access.

Jeanne du Fay de Lavallaz; Frank Matthias Bogun; Jackson Jeikai Liang

doi:10.1007/s10840-026-02413-8

July 27, 2026Journal of Interventional Cardiac ElectrophysiologyOpen Access

Needle-in-needle micropuncture epicardial access: minimizing needle size to maximize safety?

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Why the study?

Does a needle-in-needle micropuncture technique provide safe and successful epicardial access in patients undergoing VT ablation?

Key Points

Evaluate the procedural feasibility, acute safety profile, and technical workflow of a standardized needle-in-needle micropuncture technique for percutaneous epicardial access during ventricular tachycardia ablation.
Editorial appraisal of a single-center cohort examining 40 consecutive patients undergoing epicardial ventricular tachycardia ablation between 2020 and 2025.
Assessed a coaxial needle-in-needle system featuring an 18-gauge outer needle and a 21-gauge inner micropuncture needle advanced via a subxiphoid approach under 90° left lateral fluoroscopy.
Zero major access-related complications occurred in the 40-patient cohort treated by a single experienced operator.
The technique was evaluated exclusively in patients without prior cardiac surgery, pericarditis, prior epicardial ablation, or known pericardial adhesions, precluding conclusions about superiority over conventional access.

Structured PICO

Does a needle-in-needle micropuncture technique provide safe and successful epicardial access in patients undergoing VT ablation?

P

Population

40 consecutive selected patients without prior cardiac surgery or pericardial adhesions undergoing epicardial access for ventricular tachycardia ablation.

I

Intervention

Needle-in-needle (NIN) micropuncture technique for percutaneous epicardial access (18-gauge outer access needle and a 21-gauge inner micropuncture needle)

O

Outcome

Successful epicardial access and major access-related complicationssafety

Limitations

Small sample size of 40 patients
Single-center experience with all procedures performed by a single experienced operator
No contemporaneous conventional large-bore control cohort for comparison
Detailed access timestamps and needle redirection events were not prospectively collected
Long-term arrhythmia outcomes were not evaluated
Performance in post-surgical patients or those with prior pericardial inflammation remains uncertain
Small sample size (40 patients)
Single experienced operator
No contemporaneous conventional large-bore control cohort
Selected cohort excluding patients with expected pericardial adhesions

Implication

The needle-in-needle micropuncture technique represents a feasible and acutely safe refinement for epicardial access during VT ablation in carefully selected patients without prior pericardial adhesions.

Abstract

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Discussion

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Cite This Study

Lavallaz et al. (2026) conducted an editorial in Ventricular tachycardia requiring epicardial access for ablation (n=40). Needle-in-needle (NIN) micropuncture technique was evaluated on Successful epicardial access.

synapsesocial.com/papers/6ad115dd00741cc3fba7dac0 https://doi.org/10.1007/s10840-026-02413-8

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Ask AI

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Needle-in-needle micropuncture epicardial access: minimizing needle size to maximize safety?

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Needle-in-needle micropuncture epicardial access: minimizing needle size to maximize safety?

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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