Guidewire Ablation via Coronary Venous System for Frequent VPBs: A Case Report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Ventricular premature beats (n=1). Intervention: Percutaneous guidewire ablation via the coronary venous system. Primary outcome: Elimination of ventricular premature beats.

Ling Jiang; Jichun Liu; Tao Ge; Jun Tang; Youquan Wei

doi:10.1155/cric/1553244

January 1, 2026Case Reports in CardiologyOpen Access

Guidewire Ablation via Coronary Venous System for Frequent VPBs: A Case Report

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Key result

Coronary venous guidewire ablation completely eliminates refractory LV summit ventricular premature beats without complications.

n=1

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Why the study?

Ventricular arrhythmias originating from the left ventricular summit are challenging to treat with conventional catheter ablation due to complex anatomy, epicardial fat, and proximity to coronary arteries.

Key Points

To describe the procedural technique and safety of percutaneous guidewire ablation via the coronary venous system for drug- and catheter-refractory ventricular premature beats originating from the left ventricular summit.
Evaluated a 60-year-old Asian female presenting with a 1-year history of palpitations and a 23% ventricular premature beat burden unresponsive to metoprolol, amiodarone, and standard catheter ablation.
Mapped the coronary venous system with a Runthrough guidewire and confirmed the earliest activation site at the distal great cardiac vein, preceding the surface QRS complex by 31 ms.
Performed guidewire ablation using a 10 mm exposed tip at 20 W for a cumulative duration of 20 s, maintaining a safe separation distance exceeding 5 mm from major coronary arteries under multiprojection angiography.
Guidewire ablation completely eliminated the ventricular premature beats and fully resolved the patient's palpitations.
Multiprojection angiography confirmed no coronary artery injury, thrombosis, or procedural complications, with preserved guidewire integrity postoperatively.
Follow-up revealed no recurrence of ventricular premature beats alongside preserved, normal left ventricular systolic function.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 60-year-old female with a 1-year history of drug-refractory, frequent ventricular premature beats originating from the left ventricular summit.

I

Intervention

Percutaneous guidewire ablation via the coronary venous system (CVS) using a Runthrough guidewire (10 mm exposure length, 20 W output power, cumulative ablation time of 20 seconds).

O

Outcome

Elimination of ventricular premature beats (VPBs) and resolution of palpitationssurrogate

Percutaneous guidewire ablation via the coronary venous system offers a feasible and safe complementary therapeutic strategy for complex, drug-refractory ventricular arrhythmias originating from the left ventricular summit when traditional ablation fails.

Limitations

Applicability is constrained by anatomical variations of the coronary venous system.
The correlation between ablation power and the incidence of steam pops needs further verification by large-sample case series.
Further prospective studies and long-term follow-up are warranted to optimize ablation parameters and evaluate long-term efficacy.
Applicability is constrained by anatomical variations of the coronary venous system
Requires further prospective studies and large-sample case series to verify safety and long-term efficacy

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Implication

May support feasibility for refractory LV summit VPBs after failed ablation; leaves open need for prospective validation.

Abstract

Background Ventricular arrhythmias originating from the left ventricular summit (LVS) are challenging to treat with conventional catheter ablation due to the region′s complex anatomy, proximity to coronary arteries, and epicardial fat coverage. Percutaneous guidewire ablation via the coronary venous system (CVS) provides a minimally invasive therapeutic option for refractory arrhythmias in this area. Case Presentation Herein, we present the case of a 60‐year‐old Asian female patient who had a 1‐year history of palpitations and was diagnosed with symptomatic, frequent ventricular premature beats (VPBs). The patient exhibited an inadequate response to metoprolol and amiodarone as pharmacological therapy and conventional ablation approaches. Following guidewire ablation via the CVS, the VPBs were eliminated entirely, her palpitations fully resolved, and no procedure‐related complications, such as coronary artery injury or thrombosis, were observed. During follow‐up, there was no recurrence of VPBs, and left ventricular function remained normal. Conclusion By employing precise mapping, individualized parameter settings, and strict safety monitoring, percutaneous guidewire ablation via the CVS can effectively treat drug‐refractory VPBs originating from the LVS. Importantly, this approach could serve as a complementary option when traditional ablation methods are unsuccessful, offering a feasible therapeutic strategy for complex ventricular arrhythmias.

Discussion

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Cite This Study

Jiang et al. (2026) conducted a case report in Ventricular premature beats (n=1). Percutaneous guidewire ablation via the coronary venous system was evaluated on Elimination of ventricular premature beats. Percutaneous guidewire ablation via the coronary venous system completely eliminated drug-refractory ventricular premature beats originating from the left ventricular summit without complications.

synapsesocial.com/papers/6a5600ff10535b590d162441 https://doi.org/10.1155/cric/1553244

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Guidewire Ablation via Coronary Venous System for Frequent VPBs: A Case Report

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Guidewire Ablation via Coronary Venous System for Frequent VPBs: A Case Report

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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