Ventricular tachycardia (VT) arising from the right or left ventricular outflow tract (OT) is a recognized arrhythmia in individuals with structurally normal hearts. Treatment options for OTVT include medications, ablation and, rarely, an implantable cardioverter defibrillator (ICD). In the past few years ablation techniques have developed to the point where most OTVTs can be successfully ablated. However, a percentage of cases have remained where ablation is unsuccessful. Some of these cases may represent an epicardial focus of the VT. Several approaches to epicardial VT ablation have been described. We recently described a LVOT-VT variant, which may be epicardial in nature, in a group of patients in whom prior ablation attempts had failed. A trans-aortic ablation approach to outflow tract VT was successful in these patients.