Feasibility of remote magnetic navigation for epicardial ablation
A 78-year-old male with chronic ischaemic heart disease was referred for recurrent episodes of VT treated by implantable cardioverter defibrillator (ICD) discharges. He had previously undergone an endocardial VT ablation. His recent CAG showed a chronic total right coronary artery occlusion with good collateral flow and no progression over time. Under treatment with bisoprolol, amiodarone, phenytoin, and lidocaine the clinical VT with a cycle length of 430 ms was reproducibly induced during the invasive EP study. Endocardial and epicardial mapping indentified a substrate in the inferior scar of myocardial infarction.\nThirty-three RF pulses were applied with a mean energy of 34 W from both epicardial and endocardial access in order to obtain scar homogenisation. At the conclusion of the procedure the VT was no longer inducible. There was no significant pericardial bleeding during and after the procedure. The patient was discharged home on oral bisoprolol, amiodarone, and phenytoin. At 3-month follow-up the patient was free of sustained ventricular arrhythmias.