Ventricular arrhythmias originating from the left ventricular summit and intramyocardially within the interventricular septum pose a serious challenge for catheter ablation. Myocardial thickness, epicardial fat, and coronary vessels impede appropriate radiofrequency energy delivery.
Intracoronary mapping followed by intramyocardial ablation using radiofrequency (RF) ablation delivered through a system routinely used to treat coronary artery chronic total occlusions is feasible and effective. Unlike alcohol injection and coil embolization of septal perforator arteries, intramyocardial RF ablation using this technique is a more localized and limited approach that carries less risk of complete atrioventricular block and myocardial injury.
Jorge Romero, MD; Juan Carlos Diaz, MD; Justin Hayase, MD; Ravi H Dave, MD; Jason S. Bradfield, MD; Kalyanam Shivkumar, MD-PhD. Intramyocardial Radiofrequency Ablation of Ventricular Arrhythmias Using Intracoronary Wire Mapping and a Coronary Reentry System. Description of a Novel Technique. Heart Rhythm Case Reports. 2018: Volume 4, Issue 7:285-292.
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