Needle-in-needle micropuncture technique for epicardial access during ventricular tachycardia ablation
- 1Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- 2German Center for Cardiovascular Research (DZHK), Partner Site Lübeck, Germany
- 3Department of Rhythmology, University Heart Center, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, 23562 Germany
Abstract
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. We aimed to describe a standardized workflow and assess the feasibility and acute safety of epicardial access for VT ablation using a NiN micropuncture technique.
Methods: This retrospective, single-center observational study without a comparator group included 40 consecutive patients who underwent epicardial access for VT ablation using the NiN micropuncture technique between January 2020 and July 2025. Baseline clinical characteristics, procedural details, success of epicardial access, and acute access-related complications were evaluated.
Results: Nurse-administered propofol sedation was used in 37 patients (93%). The median total procedure time was 141 min. Epicardial access was successfully achieved in all patients (100%). No major access-related complications occurred, including cardiac tamponade, significant bleeding, or coronary artery injury. 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.
Conclusion: Epicardial access using a NiN micropuncture technique was feasible and acutely safe for VT ablation, achieving a 100% access success rate with no major puncture-related complications.
Related
- Transatrial air-assisted epicardial ventricular tachycardia ablation for hypertrophic cardiomyopathy and management of postprocedural right atrial thrombus.
- Thirty years of percutaneous epicardial access: reflections on the evolution of ventricular tachycardia substrate mapping and ablation
- Multicenter Coronary Venous Carbon Dioxide Insufflation for Subxiphoid Epicardial Access in Ventricular Tachycardia Ablation.
- Global Advances in Ventricular Tachycardia Ablation
- Elimination of Epicardial Late Potentials by Endocardial Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy
BibTeX
@article{tilz2026needleinneedle,
title = {{Needle-in-needle micropuncture technique for epicardial access during ventricular tachycardia ablation}},
author = {Roland Richard Tilz and Roman Mamaev and Sascha Hatahet and Tuğba Aktemur Özalp and Sorin Stefan Popescu and Jan-Per Wenzel and Mirco Küchler and Charlotte Eitel and Karl-Heinz Kuck and Kohei Ukita},
journal = {Journal of Interventional Cardiac Electrophysiology},
year = {2026},
month = jul,
doi = {10.1007/s10840-026-02400-z},
url = {https://doi.org/10.1007/s10840-026-02400-z},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Needle-in-needle micropuncture technique for epicardial access during ventricular tachycardia ablation
AU - Roland Richard Tilz
AU - Roman Mamaev
AU - Sascha Hatahet
AU - Tuğba Aktemur Özalp
AU - Sorin Stefan Popescu
AU - Jan-Per Wenzel
AU - Mirco Küchler
AU - Charlotte Eitel
AU - Karl-Heinz Kuck
AU - Kohei Ukita
PY - 2026
DA - 2026/07/21
JO - Journal of Interventional Cardiac Electrophysiology
DO - 10.1007/s10840-026-02400-z
UR - https://doi.org/10.1007/s10840-026-02400-z
AB - 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. We aimed to describe a standardized workflow and assess the feasibility and acute safety of epicardial access for VT ablation using a NiN micropuncture technique. Methods: This retrospective, single-center observational study without a comparator group included 40 consecutive patients who underwent epicardial access for VT ablation using the NiN micropuncture technique between January 2020 and July 2025. Baseline clinical characteristics, procedural details, success of epicardial access, and acute access-related complications were evaluated. Results: Nurse-administered propofol sedation was used in 37 patients (93%). The median total procedure time was 141 min. Epicardial access was successfully achieved in all patients (100%). No major access-related complications occurred, including cardiac tamponade, significant bleeding, or coronary artery injury. 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. Conclusion: Epicardial access using a NiN micropuncture technique was feasible and acutely safe for VT ablation, achieving a 100% access success rate with no major puncture-related complications.
SN - 1383-875X
SN - 1572-8595
ER -