{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T23:18:45Z","timestamp":1773703125912,"version":"3.50.1"},"reference-count":80,"publisher":"IMR Press","issue":"1","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>Epicardial ablation is an increasingly important treatment for refractory ventricular tachycardia (VT), particularly in nonischemic cardiomyopathy or when the substrate is epicardial or mid-myocardial. This review provides an overview of the pathophysiology and disease-specific characteristics of VT substrates, with a particular focus on epicardial involvement and indications based on electrocardiographic, imaging, and clinical findings. We present advanced substrate-mapping strategies, including functional and high-resolution approaches, and practical examples of three-dimensional mapping using the CARTO\u2122 (Biosense Webster, Diamond Bar, CA, USA) and EnSite\u2122 (Abbott, Abbott Park, IL, USA) systems to overcome the known limitations of conventional mapping techniques. In the latter part of the review, we discuss the technical aspects of epicardial access, as well as the clinical challenges and strategies for challenging scenarios, such as bipolar ablation and ablation after prior cardiac surgery, supported by practical examples from our institution. We also highlight future perspectives. These insights are expected to contribute to the optimization of treatment strategies for refractory epicardial VT and to support the development of more precise and durable patient care.<\/jats:p>","DOI":"10.31083\/rcm44332","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:36:20Z","timestamp":1769686580000},"source":"Crossref","is-referenced-by-count":1,"title":["Epicardial Ventricular Tachycardia Ablation: A Contemporary Review of Indications, Techniques, and Practical Approaches for Challenging Substrates"],"prefix":"10.31083","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4539-574X","authenticated-orcid":true,"given":"Maiko","family":"Kuroda","sequence":"first","affiliation":[{"name":"Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, 802-8555 Fukuoka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenichi","family":"Hiroshima","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, 802-8555 Fukuoka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Ando","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, 802-8555 Fukuoka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"16242","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, et al. 2017 AHA\/ACC\/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. 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Virchows Archiv: an International Journal of Pathology. 2019; 475: 279\u2013301.","DOI":"10.1007\/s00428-019-02615-8"},{"key":"ref38","doi-asserted-by":"publisher","unstructured":"Okubo K, Gigli L, Trevisi N, Foppoli L, Radinovic A, Bisceglia C, et al. Long-Term Outcome After Ventricular Tachycardia Ablation in Nonischemic Cardiomyopathy: Late Potential Abolition and VT Noninducibility. Circulation. Arrhythmia and Electrophysiology. 2020; 13: e008307.","DOI":"10.1161\/CIRCEP.119.008307"},{"key":"ref39","doi-asserted-by":"publisher","unstructured":"Haberka M, Rajewska-Tabor J, Wojtowicz D, Jankowska A, Miszalski-Jamka K, Janus M, et al. A distinct septal pattern of late gadolinium enhancement specific for COVID-induced myocarditis: A multicenter cardiovascular magnetic resonance study. Kardiologia Polska. 2023; 81: 463\u2013471.","DOI":"10.33963\/KP.a2023.0054"},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"Liang JJ, Castro SA, Muser D, Briceno DF, Shirai Y, Enriquez A, et al. Electrophysiologic Substrate, Safety, Procedural Approaches, and Outcomes of Catheter Ablation for Ventricular Tachycardia in Patients After Aortic Valve Replacement. JACC. Clinical Electrophysiology. 2019; 5: 28\u201338.","DOI":"10.1016\/j.jacep.2018.08.008"},{"key":"ref41","doi-asserted-by":"publisher","unstructured":"Soejima K, Nogami A, Sekiguchi Y, Harada T, Satomi K, Hirose T, et al. Epicardial catheter ablation of ventricular tachycardia in no entry left ventricle: mechanical aortic and mitral valves. Circulation. Arrhythmia and Electrophysiology. 2015; 8: 381\u2013389.","DOI":"10.1161\/CIRCEP.114.002517"},{"key":"ref42","doi-asserted-by":"publisher","unstructured":"Aziz Z, Shatz D, Raiman M, Upadhyay GA, Beaser AD, Besser SA, et al. Targeted Ablation of Ventricular Tachycardia Guided by Wavefront Discontinuities During Sinus Rhythm: A New Functional Substrate Mapping Strategy. Circulation. 2019; 140: 1383\u20131397.","DOI":"10.1161\/CIRCULATIONAHA.119.042423"},{"key":"ref43","doi-asserted-by":"publisher","unstructured":"Arenal A, Glez-Torrecilla E, Ortiz M, Villacast\u00edn J, Fdez-Portales J, Sousa E, et al. Ablation of electrograms with an isolated, delayed component as treatment of unmappable monomorphic ventricular tachycardias in patients with structural heart disease. Journal of the American College of Cardiology. 2003; 41: 81\u201392.","DOI":"10.1016\/s0735-1097(02)02623-2"},{"key":"ref44","doi-asserted-by":"publisher","unstructured":"Ja\u00efs P, Maury P, Khairy P, Sacher F, Nault I, Komatsu Y, et al. Elimination of local abnormal ventricular activities: a new end point for substrate modification in patients with scar-related ventricular tachycardia. 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Arrhythmia and Electrophysiology. 2016; 9: e004072.","DOI":"10.1161\/CIRCEP.116.004072"},{"key":"ref55","doi-asserted-by":"publisher","unstructured":"Katritsis G, Kailey B, Jamil-Copley S, Luther V, Koa-Wing M, Cortez-Dias N, et al. RIPPLE-VT study: Multicenter prospective evaluation of ventricular tachycardia substrate ablation by targeting scar channels to eliminate latest scar potentials without direct ablation. Heart Rhythm. 2024; 21: 2481\u20132490.","DOI":"10.1016\/j.hrthm.2024.05.046"},{"key":"ref56","doi-asserted-by":"publisher","unstructured":"Braunstein ED, Gabriels JK, Ehdaie A, Yarnitsky J, Liu H, Ramireddy A, et al. Insights from the use of multipolar mapping during ablation of supraventricular and ventricular arrhythmias. Heart Rhythm O2. 2025; 6: 402\u2013409.","DOI":"10.1016\/j.hroo.2025.01.005"},{"key":"ref57","doi-asserted-by":"publisher","unstructured":"Kono H, Hiroshima K, Korai K, Ando K. 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Bipolar radiofrequency ablation for ventricular tachycardias originating from the interventricular septum: Safety and efficacy in a pilot cohort study. Heart Rhythm. 2020; 17: 2111\u20132118.","DOI":"10.1016\/j.hrthm.2020.06.025"},{"key":"ref72","doi-asserted-by":"publisher","unstructured":"Yamada T, Doppalapudi H, Litovsky SH, McElderry HT, Kay GN. Challenging Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating From the Left Ventricular Summit Near the Left Main Coronary Artery. Circulation. Arrhythmia and Electrophysiology. 2016; 9: e004202.","DOI":"10.1161\/CIRCEP.116.004202"},{"key":"ref73","doi-asserted-by":"publisher","unstructured":"Enriquez A, Hanson M, Nazer B, Gibson DN, Cano O, Tokioka S, et al. Bipolar ablation involving coronary venous system for refractory left ventricular summit arrhythmias. 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