Left internal thoracic artery injury in percutaneous epicardial access for catheter ablation: Prevention and management

Since the first report of successful epicardial ablation in the late 1990s from Sosa et al,1 it has become a vital treatment option for ventricular arrhythmias.2,3 However, despite its efficacy, this technique also has risks, including potential complications related to epicardial needle trajectory.3,4 One complication involves injury to the left internal thoracic artery (LITA), which typically courses approximately 1 cm from the sternal margin and bifurcates around the sixth intercostal space. Although this potential complication has been recognized,5 it remains under-reported in the literature, with only a limited number of documented cases.