Radiofrequency ablation of ventricular tachycardia via epicardial access in a patient with pericardial adhesions

Epicardial ablation is an effective treatment for ventricular tachycardia in large-scale hospitals when endocardial intervention is failed. Pericardial adhesions are rare in patients without previous cardiac surgery, pericarditis, or pericardial punctures. Traditional method for pericardial separation is creation of “surgical window” for dissection of adhesions under direct visualization. This case describes successful elimination of epicardial ventricular tachycardia in a patient with adhesions in the isthmus zone that required dissection of adhesions. Dissection was performed in “blunt” manner using ablation catheter without the need for “surgical window”. Intraoperative success was achieved with ablation in the area of adhesive process. No complications, including those associated with dissection of adhesions, were recorded. This case demonstrates the effectiveness and safety of “blunt” percutaneous dissection of pericardial adhesions.