Feasibility of remote magnetic navigation for epicardial ablation
A 50-year-old male presented with frequent PVCs causing marked exercise intolerance. His Holter recording revealed a high number of monomorphic PVCs (27,000/24 h) with bigeminy. Left ventricular ejection fraction was normal. Neither syncope nor sustained ventricular arrhythmias were documented, and the family history was unremarkable. During the previous invasive EP study an ablation had not been performed due to the absence of an adequate pace-map. Using the MNS to guide the catheter, a perfect 12 out of 12 pace-map was gained from the anterior epicardial aspect of the LVOT (Fig. ).\nDelivery of three RF applications with an average energy of 27 W terminated the arrhythmia and rendered it non-inducible (also with isoproterenol infusion). The successful ablation site was 7 mm away from the left main coronary stem (Fig. ). No acute complications were observed, but in the early post-procedure period the patient developed a self-limiting sterile pericarditis with an insignificant amount of pericardial fluid. At follow-up after 3 months, PVCs were absent and the patient reported an improved physical condition. His prior antiarrhythmic medication was discontinued.