Iatrogenic pleuropericardial communication: A rare complication of percutaneous epicardial mapping

Ablation of ventricular tachycardia (VT) is a wellestablished treatment for patients with recurrent implantable cardioverter-defibrillator shocks. Epicardial access is increasingly performed when epicardial arrhythmogenic substrate is suspected and may be considered as a first-line approach in the subset of myocardial diseases with preferential epicardial substrate, namely, idiopathic dilated cardiomyopathy, arrhythmogenic right ventricular dysplasia, or chagasic cardiomyopathy. Cardiac complications of this approach include right ventricular puncture, pericardial bleeding, coronary vessel damage, and pericarditis. Damage to extracardiac structures may occur during puncture, mapping, and ablation; deep knowledge of the anatomic relationships of the heart and prompt recognition of complications are paramount to minimize procedural risk. We report the first case of acute iatrogenic pleuropericardial communication during epicardial mapping in a patient with chagasic cardiomyopathy.