{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T17:17:58Z","timestamp":1778779078446,"version":"3.51.4"},"reference-count":16,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Epicardial mapping and ablation of ventricular tachycardia (VT) are used in different clinical situations but pericardial adhesions following prior cardiac surgery or previous epicardial procedures may limit a percutaneous approach. The objective of this case series is to evaluate the safety and feasibility of a hybrid approach with surgical epicardial access as a valid alternative when pericardial space is not accessible percutaneously. Methods: After a complete preprocedural evaluation, four patients with prior cardiac surgery underwent hybrid VT ablation under general anesthesia. Surgical subxiphoid access was performed in three cases and one patient was subjected to median resternotomy for concomitant open-heart surgery. Epicardial electroanatomic voltage maps were acquired using the CARTO 3 system (Biosense Webster) or NavX (St. Jude Medical) and VT ablations with irrigated catheters were performed. The procedural endpoint was VT non-inducibility and\/or LAVA\/LP abolition. Results: No serious periprocedural complications occurred after hybrid VT ablation. Three patients had no complex ventricular arrhythmias after a median follow-up of 43 months. A symptomatic sustained VT relapsed in one patient, without requiring a redo ablation procedure but responded to escalation of antiarrhythmic therapy. Conclusions: A carefully planned hybrid VT ablation with surgical epicardial access is a safe and feasible procedure in patients with epicardial scar-related re-entry circuits and pericardial adhesions that limit a percutaneous approach.<\/jats:p>","DOI":"10.3390\/jcm15103782","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T16:27:56Z","timestamp":1778776076000},"page":"3782","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hybrid Surgical\u2013Catheter Epicardial Ablation of Ventricular Tachycardia: A Case Series"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-4979-5515","authenticated-orcid":false,"given":"Alessandro","family":"Telesca","sequence":"first","affiliation":[{"name":"Cardiothoracic Department, University Hospital Santa Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6200-4088","authenticated-orcid":false,"given":"Roberto","family":"Scacciavillani","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, 20123 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3236-3458","authenticated-orcid":false,"given":"Gemma","family":"Pelargonio","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, 20123 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1780-1803","authenticated-orcid":false,"given":"Cristina","family":"Conte","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, University Hospital Santa Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico","family":"Ballacci","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, University Hospital Santa Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5479-5847","authenticated-orcid":false,"given":"Federica","family":"Giordano","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, University Hospital Santa Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Perna","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4737-1143","authenticated-orcid":false,"given":"Gianluigi","family":"Bencardino","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1640-9428","authenticated-orcid":false,"given":"Francesco","family":"Spera","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliero Universitaria Sant\u2019Andrea, 00189 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6642-1682","authenticated-orcid":false,"given":"Gaetano","family":"Pinnacchio","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Scapigliati","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario \u201ca. Gemelli\u201d IRCCS, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimo","family":"Massetti","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, 20123 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6569-9401","authenticated-orcid":false,"given":"Francesco","family":"Burzotta","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, 20123 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5722-0245","authenticated-orcid":false,"given":"Massimo","family":"Imazio","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, University Hospital Santa Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy"},{"name":"Department of Medicine (DMED), University of Udine, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8682-0322","authenticated-orcid":false,"given":"Maria Lucia","family":"Narducci","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1111\/j.1540-8167.1996.tb00559.x","article-title":"A New Technique to Perform Epicardial Mapping in the Electrophysiology Laboratory","volume":"7","author":"Sosa","year":"1996","journal-title":"J. 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