Key result
Needle-in-needle micropuncture technique achieves ~100% epicardial access success during VT ablation with no major access complications.
Why the study?
Epicardial access for VT ablation carries potentially serious complications such as cardiac tamponade and coronary artery injury. The safety and efficacy of a needle-in-needle micropuncture technique to reduce myocardial trauma and improve procedural safety required evaluation.
Does the needle-in-needle micropuncture technique provide safe and effective epicardial access in patients undergoing ventricular tachycardia ablation?
Observational (n=40)
Does the needle-in-needle micropuncture technique provide safe and effective epicardial access in patients undergoing ventricular tachycardia ablation?
The needle-in-needle micropuncture technique for epicardial access during VT ablation demonstrated a 100% success rate with no major puncture-related complications, offering a potentially safer alternative to conventional large-bore needles.
Supports micropuncture epicardial access evaluation in VT ablation; leaves open randomized confirmation of safety versus conventional techniques.
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. Purpose To evaluate the safety and efficacy of epicardial access for VT ablation using a NiN micropuncture technique. Methods We retrospectively analyzed 40 consecutive patients (median age, 64 years; 23% female; 20% with ischemic cardiomyopathy) who underwent epicardial access for VT ablation using the NiN micropuncture technique between January 2020 and July 2025. Baseline clinical characteristics, procedural details, procedure-related complications, and arrhythmia recurrence rate were assessed. Recurrence was defined as documented VT or ventricular fibrillation lasting ≥ 30 seconds, or appropriate implantable cardioverter defibrillator therapy. Results Epicardial access was successfully achieved in all patients (Table A). The median total procedure time was 141 minutes. No major access-related complications occurred, including cardiac tamponade, significant bleeding, or coronary artery injury (Table B). 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. During a mean follow-up of 122 days, recurrence was observed in 17 patients (43%). Conclusions Epicardial access using a NiN micropuncture technique is feasible and acutely safe for VT ablation, with a 100% access success rate and no major puncture-related complications. This technique represents a promising alternative to conventional large-bore epicardial needles for VT ablation. Prospective comparative studies and longer-term follow-up are warranted to further define its safety profile and clinical impact.
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Ukita et al. (2026) conducted an observational in Ventricular tachycardia (n=40). Needle-in-needle (NiN) micropuncture technique for epicardial access was evaluated on Epicardial access success rate, major access-related complications, and arrhythmia recurrence. The needle-in-needle micropuncture technique achieved 100% epicardial access success with 0% major access-related complications and a 43% VT recurrence rate over 122 days.
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