Safety and efficacy of needle-in-needle micropuncture technique for epicardial access during ventricular tachycardia ablation
K Ukita, R Mamaev, S Popescu, J P Wenzel, C Eitel, R TilzAbstract
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.Table