Recommendations for epicardial access for catheter ablation

COR	LOE	Recommendations
I	C-EO	1. In patients undergoing epicardial VT ablation, imaging of the epicardial coronary arteries by coronary arteriography or coronary computed tomography angiogram prior to ablation is recommended to reduce the risk of arterial injury.
I	C-EO	2. In patients undergoing epicardial VT ablation via a percutaneous approach, provision for immediate echocardiography, blood transfusion, and onsite cardiothoracic surgical backup is recommended.
I	C-EO	3. In patients with prior cardiac surgery or pericardial adhesions for whom epicardial VT ablation via a percutaneous approach is considered, careful assessment of the risk/benefit ratio and alternative therapies such as surgical dissection are recommended.
I	C-EO	4. In patients undergoing epicardial VT ablation, pacing with high stimulus intensity from the ablation electrode to rule out diaphragmatic stimulation is recommended to avoid phrenic nerve injury.