BACKGROUND For ventricular arrhythmias (VAs) originating from the left ventricular epicardium adjacent to the transitional area from the great cardiac vein to the anterior interventricular vein (DGCV-AIV), the most efficient catheter manipulation approach has not been fully elucidated. OBJECTIVE This study aimed to investigate a more appropriate catheter manipulation approach for DGCV-AIV VAs. METHODS One hundred twenty-three consecutive patients with DGCV-AIV VAs were retrospectively analyzed. All these patients were firstly mapped and ablated by conventional approach （Non-Swartz sheath support (NS) approach）. When target sites not been reached, Swartz sheath support (SS) approach was attempted. If target sites still unreached, the hydrophilic coated guide wire and left coronary angiographic catheter-guided deep engagement of Swartz sheath in GCV to support ablation catheter was performed. RESULTS A total of one hundred three VAs (103/123, 83.74%) were successfully eliminated in DGCV-AIV. By NS approach, the tip of catheter reached DGCV in 39.84% VAs (49/123), reached target sites in 35.87% VAs (44/123), and achieved successful ablation in 30.89% VAs (38/123), which was significantly lower than by SS approach (88.61% (70/79), 87.34 % (69/79), and 84.81% (67/79), P<0.05). In left anterior oblique (LAO) view, angle between DGCV and AIV<83° indicated an inaccessible AIV by catheter tip with a predictive value of 94.5%. Width/height of coronary venous system>0.69 more favored a SS approach with a predictive value of 87%. CONCLUSION For RFCA of VAs arising from DGCV-AIV, the SS approach facilitates the catheter tip achieve target sites and contributes to a successful ablation.