LAUSR

Coronary vein exit with a very narrow-profile Introduction Ventricular tachycardia (VT) ablation for arrhythmogenic right ventricular dysplasia (ARVD) is a well-established therapy for arrhythmia control in circumstances of failure or intolerance to medical therapy. Thefibrofatty infiltration inherent in the pathology of ARVD generally more extensively involves the epicardium compared with the endocardium of the right ventricle (RV), and occasionally the left ventricle. Not surprisingly, VT ablation approaches limited to the endocardiummay confer more limited arrhythmia control. However, epicardial ablation has often been relegated to expert centers owing to the technical challenge associated with access and relatively high complication rates. The technical difficultywith obtaining epicardial access is heightened in patients wherein dense adhesions may be present, such as patients with a history of prior epicardial ablation, pericarditis, or cardiac surgery. Recently, a multicenter Epi-CO2 registry published the feasibility of coronary vein exit and carbon dioxide (CO2) insufflation to facilitate safe epicardial access and allow diagnosis of pericardial adhesions prior to attempted access. Here we report a case of a redo epicardial VT ablation in a patient with ARVD and dense adhesions, facilitated by CO2 insufflation. microcatheter (1.9F) may lower the bleeding risk associated with intentional coronary vein exit for use with CO2 insufflation–facilitated epicardial access. Case report A 64-year-old man was referred to our institution for a redo VT ablation. He originally presented with syncope and VT in 1997. Two separate electrophysiology studies disclosed