The evidence on percutaneous (non-thoracoscopic) epicardial catheter radiofrequency ablation for ventricular tachycardia (VT) is limited to a small number of patients, but it shows that the procedure is efficacious in carefully selected individuals and raises no major safety issues, in the context of a condition which is potentially life-threatening. Therefore, the procedure may be used with normal arrangements for clinical governance, but with special arrangements for consent.
During the consent process clinicians should ensure that patients understand the risks of potentially serious complications, including damage to the heart muscle.
Patient selection and treatment should be carried out only by a team specialising in the treatment of cardiac arrhythmias that includes experts in electrophysiology and ablation.
The procedure should only be carried out by interventional cardiologists with specific training in electrophysiology and in accessing the pericardial space and performing complex ablation procedures.
The procedure should only be carried out in units with arrangements for emergency cardiac surgical support in case of complications.
The National Institute for Cardiovascular Outcomes Research runs the UK Central Cardiac Audit Database (UKCCAD), and clinicians should enter details about all patients undergoing percutaneous (non-thoracoscopic) epicardial catheter radiofrequency ablation for VT onto this database.
NICE encourages further research into and publication of the outcomes and potential serious complications of percutaneous (non-thoracoscopic) epicardial catheter radiofrequency ablation for VT in larger numbers of patients.