We present a case of a 67-year-old patient with nonischemic cardiomyopathy and recurrent sustained ventricular tachycardia of epicardial origin referred for ablation. Due to two previous episodes of cardiac tamponade secondary to implantable cardioverter-defibrillator lead perforation at the time of device implant, the patient had significant pericardial adhesions making epicardial access and ablation challenging.