Both radiofrequency (RF) and cryothermal energy have been used in catheter ablations to treat atrial and ventricular arrhythmias, from both the endocardium and the epicardium. The underlying mechanisms leading to focused myocyte death and ablation efficacy differ between the 2 energy sources, with the most obvious and simplest difference being that RF ablation works through tissue heating, whereas cryothermal ablation is carried out by tissue freezing. However, key differences also exist in the ambient environments and structures of the endocardial and pericardial spaces. These differences affect the approach to epicardial catheter ablation using either energy source. Understanding these differences as well as a basic understanding of endocardial ablation biophysics is critical to understanding how ablation approaches differ on the epicardium. In this article, these concepts are reviewed in the context of ventricular arrhythmia ablation.
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