Parasternal intercostal approach as an alternative to subxiphoid approach for epicardial catheter ablation: A case report

Introduction The importance of an epicardial substrate for cardiac arrhythmias has been increasingly recognized. Combined endocardial and epicardial mapping and radiofrequency catheter ablation (RFCA) has become the standard strategy for treatment of ventricular tachycardia (VT). The subxiphoid approach is the standard and most frequently used method for percutaneous epicardial access. However, complications of the subxiphoid approach are not uncommon, even in experienced centers, with reported rates of 4% to 7%. In addition, obtaining epicardial access using the subxiphoid approach may be difficult because of extracardiac structures located on the epicardial needle trajectory. Therefore, the epicardial approach to reduce complications and as an alternative to the subxiphoid approach is essential for epicardial RFCA. We described the case of a patient with successful epicardial access twice and RFCA using a parasternal intercostal approach, which is an alternate solution when the standard subxiphoid approach to obtain epicardial access is difficult.