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Percutaneous Epicardial Approach to Catheter Ablation of Cardiac Arrhythmias (JACC: Clinical Electrophysiology January 2020)
Percutaneous Epicardial Approach to Catheter Ablation of Cardiac Arrhythmias
This review discusses the rationale and indications for epicardial catheter mapping and/or ablation. This paper also reviews the prevalence of epicardial arrhythmias and their electrocardiographic criteria. In addition, it examines the anatomy of the pericardium and commonly used epicardial access techniques, as well as the optimal methodologies for epicardial mapping and ablation and the impact of epicardial fat. Finally, this review discusses the potential of the various complications associated with the percutaneous epicardial approach, in addition to patient specific risk factors, and potential strategies to mitigate the risk of complications.

David J. Wilber, MD, FACC

CME Editor
Smit Vasaiwala, MD

Arash Aryana, MD, PHD
Roderick Tung, MD

CME Information
Target Audience
JACC Journal CME is intended for physicians who treat patients with cardiovascular disease.

Important Dates
Date of Release: January 20, 2020
Term of Approval/Date of CME/MOC/ECME Expiration: January 19, 2021

Learner Objectives
After reading this article the reader should be able to:
  • Explain how the critical anatomic substrate in certain patients with cardiac arrhythmias, particularly those with ventricular tachycardia, may occur in intramural or subepicardial myocardium.
  • Deduce that successful elimination of these substrates invariably requires epicardial mapping and ablation.
  • Illustrate that, despite great similarities between epicardial and endocardial catheter mapping/ablation, there are fundamental differences that can significantly impact this approach within the pericardial space.
  • Recognize that knowledge of the regional anatomy and potential risk factors for complications is key to mitigating the risk for adverse events.
Method of Participation and Claiming Credit
This ACC JACC Journals CME/MOC/ECME activity includes the reading of an article published in one of the JACC journals and the successful completion of self-assessment questions. 

Requesting AMA PRA Category 1 CME Credit™ and/or MOC or ECME credit for this Activity

To request credit, you must:
  1. Read the article for which you wish to receive credit.
  2. Answer the self-assessment questions. You need to have achieved a passing score of 70% or better in order for the Evaluation link to become activated. If you did not achieve a passing score, please click on the Posttest link in the left navigation bar and retake the exam.
  3. After you complete the Evaluation, click on the Claim Credit button in the left navigation bar.
  4. For CME or COP credit, enter the total amount of time you actually spent in the activity in the box provided. Please note that you may only claim once for this activity. Click Claim.
  5. For MOC credit, click the Claim button in the row for MOC. Please note that you may only claim once for this activity. Confirm your ABIM number and date of birth.
  6. For ECME credit, click the Claim button in the row for ECME. Please note that you may only claim once for this activity. Enter your date of birth and click Submit.
  7. The page will be updated with the date and time that you claimed your credit.
  8. To view your credit, or to print a certificate, please go to and navigate to the My Transcript section of My ACC.
This CME/MOC/ECME-certified activity may contain links to other educational resources such as clinical trial summaries, journal articles, guidelines, etc., that may not be CME/MOC/ECME-certified. Please note that clicking on the links provided to view these resources will open new windows, which are outside of this CME/MOC/ECME-certified activity.
Availability: On-Demand
Available Jan 20, 2020 to Jan 19, 2021
Cost: FREE
Credit Offered: 1 ABIM-MOC Point
1 CME Credit
1 ECME Credit
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