Epicardial access during electrophysiology procedures offers valuable insights and therapeutic options for managing ventricular arrhythmias (VAs). The current clinical consensus statement on epicardial VA ablation aims to provide clinicians with a comprehensive understanding of this complex clinical scenario. It offers structured advice and a systematic approach to patient management. Specific sections are devoted to anatomical considerations, criteria for epicardial access and mapping evaluation, methods of epicardial access, management of complications, training, and institutional requirements for epicardial VA ablation. This consensus is a joint effort of collaborating cardiac electrophysiology societies, including the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, the Latin American Heart Rhythm Society, and the Canadian Heart Rhythm Society.

2nd Division of Cardiology Cardiothoracic and Vascular Department Pisa University Hospital Pisa Italy

Amsterdam Cardiovascular Sciences Heart Failure and Arrhythmias Amsterdam The Netherlands

Arrhythmia Department Teknon Heart Institute Teknon Medical Center Barcelona Spain

Cardiac Arrhythmia Center Division of Cardiology at Montefiore Health System Albert Einstein College of Medicine New York USA

Cardiac Arrhythmia Center UCLA Health System Los Angeles CA USA

Cardiac Electrophysiology Section University of Pennsylvania Perelman School of Medicine Philadelphia PA USA

Cardionagiologisches Centrum Bethanien Agaplesion Markus Krankenhaus Frankfurt Main Germany

Center for Interventional Programs University of California Los Angeles CA USA

Clinic for Arrhythmology University Heart Center Nuremberg University Hospital Nuremberg South Campus Nuremberg Germany

Clinic of Electrophysiology Heart and Diabetes Center NRW Ruhr University Bochum Bad Oeynhausen Germany

Department of Cardiac Arrhythmia and Electrophysiology San Raffaele University Hospital Milan Italy

Department of Cardiology Amsterdam UMC Location University of Amsterdam Meibergdreef 9 Amsterdam The Netherlands

Department of Cardiology CHRU Nancy Université de Lorraine Nancy France

Department of Cardiology Deutsches Herzzentrum der Charité Medical Heart Center of Charité German Heart Institute Berlin Berlin Germany

Department of Cardiology Institute for Clinical and Experimental Medicine Prague Czech Republic

Department of Cardiology Leiden University Medical Center Leiden The Netherlands

Department of Cardiology University Hospital Halle Martin Luther University Halle Wittenberg Ernst Grube Str 40 06120 Halle Germany

Department of Cardiology Vanderbilt Heart and Vascular Institute Nashville TN USA

Department of Cardiology Willem Einthoven Center of Arrhythmia Research and Management Leiden University Medical Center Leiden The Netherlands

Department of Cardiovascular Medicine Kyorin University Tokyo Japan

Division of Cardiology Angiology Intensive Care Medicine EVK Düsseldorf cNEP cardiac Neuro and Electrophysiology Research Consortium Düsseldorf Germany

Division of Cardiology Department of Internal Medicine Yonsei University College of Medicine and Yonsei University Health System Seoul Republic of Korea

Division of Cardiology Queen's University Kingston Ontario Canada

Harvard Thorndike Arrhythmia Institute and Division of Cardiovascular Diseases Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA

Hospital Clínic de Barcelona Universitat de Barcelona Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain

IADI INSERM U1254 Université de Lorraine Nancy France

IHU LIRYC Electrophysiology and Heart Modeling Institute Cardiac Electrophysiology and Stimulation Department Fondation Bordeaux Université and Bordeaux University Hospital Pessac Bordeaux France

QEII Health Sciences Centre Dalhousie University Halifax Canada

Section of Cardiac Electrophysiology Hospital of the University of Pennsylvania Philadelphia PA USA

Unidad de Arritmias Servicio de Cardiología Hospital Universitario Germans Trias i Pujol Badalona Barcelona Spain

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