BACKGROUND: Perforation of a coronary venous branch for pericardial insufflation of carbon dioxide (CO OBJECTIVES: This study describes a novel and streamlined technique for pericardial CO METHODS: Between 2023 and 2024, 18 patients (age: 55 ± 11 years
left ventricular ejection fraction: 44 ± 13%) underwent epicardial access for mapping and ablation of ventricular arrhythmias facilitated by pericardial CO RESULTS: Successful RAA exit with the RF guidewire-microcatheter assembly was achieved in all patients, and epicardial access was completed in 17 (94%) patients. In 1 patient, significant pericardial adhesions were detected after RAA exit, and epicardial access was deferred. The median time from femoral venous insertion of the catheter assembly to CO CONCLUSIONS: Intentional RAA perforation for pericardial CO