Percutaneous pericar- dial access for mapping and ablation is associated with a serious complication rate of approximately 5% and tamponade from RV puncture or lac- eration that can require emergent surgery or be fatal, coronary artery injury and phrenic nerve injury can occur.S12-11,S12-12 Reported experience is from tertiary referral centers. 13. POSTMORTEM EVALUATION OF SCD Recommendations for Postmortem Evaluation of SCD References that support the recommendations are summarized in Online Data Supplement 58. COR LOE Recommendations I B-NR In victims of SCD without obvious causes, a standardized cardiac-specific autopsy is I B-NR In first-degree relatives of SCD victims who were 40 years of age or younger, cardiac evaluation is recommended, with genetic counseling and genetic testing performed as indicated by clinical findings.S13-3 IIa B-NR In victims of SCD with an autopsy that implicates a potentially heritable cardiomyopathy or absence of structural disease, suggesting a potential cardiac channelopathy, postmortem genetic testing IIa C-LD In victims of SCD with a previously identified phenotype for a genetic arrhythmia- associated disorder, but without genotyping prior to death, postmortem genetic testing can be useful for the purpose of family risk Recommendation-Specific Supportive Text 1. A comprehensive postmortem protocol has been recommended for the routine evaluation of sub- jects (typically <40 years of age) who die sud- denly without a prior diagnosis of a condition and circumstances of death that could be reasonably implicated in the cause of unexpected SCD.S13-1 One study documented the added value of post- mortem examination at a specialized cardiac with particular value for clarifying an apparent overdiagnosis of cardiomy- opathy by nonspecialized centers. Pathological findings limited to the specialized conduction sys- tem were demonstrated in 22% of cases.S13-9 A misdiagnosis of cardiomyopathy was reported in 37% of referred cases that were ultimately deter- mined to be structurally normal. 