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Ventricular tachycardia (VT) contributes to significant morbidity and mortality for patients with structural heart disease. The implantable cardioverter-defibrillator (ICD) has been demonstrated to help in reducing mortality in this patient population. The ICD, however, cannot prevent future shocks and also contributes to significant anxiety for patients. Anti-arrhythmic drugs also have limited efficacy and are frequently not tolerated owing to various side effects. Catheter ablation of VT has now been shown to reduce recurrent VT episodes in numerous randomized trials. In addition, recent publications have suggested that an early ablation procedure prior to VT development may improve patient outcomes. Although percutaneous epicardial access has been well described and is relatively safe, patients with prior surgery frequently have pericardial adhesions which make a percutaneous approach difficult and/or not feasible. In these patients, a hybrid surgical approach may be warranted for successful ablation of VT. However, the surgical approach requires detailed planning, coordination with cardiac surgeons and an integrated multidisciplinary approach. Recent studies have also been initiated to determine the value of hybrid approaches to atrial fibrillation. Further Reading: Bourke T, Mathuria N, Michowitz Y, Shivkumar K. Hybrid techniques and neuraxial modulation for treatment of ventricular tachycardia. Future Cardiol. 2011; 7(3): 273–276. Shivkumar K. Percutaneous epicardial ablation of atrial fibrillation. Heart Rhythm. 2008; 5(1): 152–154.
