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Indications for epicardial mapping of ventricular tachycardia (VT)

When do you consider epicardial mapping for ventricular tachycardia (VT)?

Mapping and ablation of ventricular tachycardia (VT) is usually done from the endocardial approach except in the following specific situations:

  1. VT in structural heart diseases with a propensity for an epicardial substrate like Chagas disease and arrhythmogenic right ventricular cardiomyopathy (ARVC/ARVD)
  2. Hyperenhancement seen in the epicardial region on contrast enhanced cardiac magnetic resonance (CMR) imaging
  3. Endocardial mapping fails to identify an endocardial scar
  4. Electrocardiographic features of clinical or induced VT indicating an epicardial focus
  5. Failed attempt at ablation by endocardial approach


  1. Fernandez-Armenta J et al. Substrate modification or ventricular tachycardia induction, mapping, and ablation as the first step? A randomized study. Heart Rhythm 2016;13:1589-1595.
MCQs in Medicine - Cardiovascular System is based on undergraduate medical curriculum. Though the questions are aimed at basic post graduate entrance examinations, candidates taking competitive exams at the post graduate exit level may also find them useful, especially the explanations for the answers. Undergraduate medical students will find them useful for answering MCQ tests in their regular exams. More than just answering MCQs, the explanations will improve the knowledge and understanding about the conditions discussed.Medicine MCQs - Cardiovascular System Kindle Edition: Click Here for a Preview Comments and suggestions are most welcome.