Novel Use of Helium Insufflation to Facilitate Epicardial Access in Ventricular Tachycardia Ablation.

INTRODUCTION

Epicardial access for ventricular tachycardia (VT) ablation is challenging in patients with prior cardiac surgery or dense pericardial adhesions. Although carbon dioxide (CO₂) insufflation has been used to improve visualization, concerns remain regarding its hemodynamic and electrophysiological effects.

METHODS AND

RESULTS

We report the first clinical use of helium to facilitate epicardial access in three patients undergoing VT ablation. All patients had ischemic cardiomyopathy, prior coronary artery bypass grafting, and failed or incomplete endocardial ablation. Helium was delivered into the pericardial space via a coronary venous microcatheter connected to an intra-aortic balloon pump (IABP) console, allowing controlled insufflation and continuous hemodynamic monitoring. Helium insufflation resulted in rapid separation of the pericardial layers, clear visualization of adhesion-free regions, and safe epicardial puncture in all cases. Epicardial mapping and radiofrequency ablation were successfully completed, achieving VT non-inducibility without hemodynamic compromise, defibrillation related issues or procedural complications.

CONCLUSION

Helium insufflation using an IABP console enabled safe and effective epicardial access in patients with complex pericardial anatomy and prior cardiac surgery. As a physiologically inert, low-viscosity, and widely available gas, helium represents a practical alternative to CO₂ for challenging epicardial VT ablation procedures and merits further evaluation in larger studies.