Epicardial fat pad ablation is conducted using a catheter (22) inserted through the chest wall, using ultrasound ablation, or using a catheter fitted with a directional ultrasound transducer and capable of being aligned with the epicardium. The epicardial fat pad locations are determined using noninvasive imaging methods, or using electrical maps. These locations are then displayed on maps or images of the heart, and thus targeted for minimally invasive or non invasive therapy. The methods of the present invention are less invasive than conventional methods of ablation, and permit flexible access to substantially any point on the epicardium. The invention concerns a system comprising a probe (22) configured for insertion into the pericardial cavity, said probe comprising at least one position sensing device (66) and a transducer (54) to transmit energy directionally to target tissue on the epicardial surface of the heart.
