We describe 3 patients with ventricular tachycardia in whom epicardial ablation was done after prior attempts of endocardial ablation had failed. Clinical ventricular tachycardia originated at the right ventricular outflow tract in one patient and near the mitral annulus in another patient. In these two cases ventricular tachycardia was mapped and successfully ablated with a percutaneous subxiphoid approach to the pericardial space. In the remaining patient, ventricular tachycardia originated near the mitral annulus and was ablated via a coronary vein. The two patients who presented tachycardiomyopathy recovered normal left ventricular function after successful ablation. Failure of endocardial ablation may reflect a substrate of epicardial arrhythmia. Epicardial ablation is effective and provides an alternative therapy for patients with ventricular tachycardia, including those with no structural heart disease.