Guidewire ablation of epicardial ventricular arrhythmia within the coronary venous system: A case report

Key Teaching Points•Ventricular arrhythmia (VA) originating from epicardial or intramural locations poses a clinical challenge for catheter ablation, and the coronary venous system may provide routes for mapping and ablation of these arrhythmias, but inability to deliver sufficient radiofrequency energy owing to anatomical constraints, high impedance, and inadequate irrigation flow may limit the efficacy of ablation.•As a novel technique, guidewire ablation through the coronary venous system is feasible and effective for treating epicardial or intramural VA. This approach overcomes the inability to advance the traditional ablation catheter in small-diameter vessels; and compared with ethanol infusion, it is more predictable to use guidewire ablation because of accurate targeting and limited myocardial injury.•The innovation of this technique outlined in our case is the usage of a microcatheter. A guidewire covered with a microcatheter can be effectively used as an “ablation electrode” for unipolar mapping and ablation; by moving the microcatheter, length variability of the wire tip is available, as well as the possibility of performing saline infusion. •Ventricular arrhythmia (VA) originating from epicardial or intramural locations poses a clinical challenge for catheter ablation, and the coronary venous system may provide routes for mapping and ablation of these arrhythmias, but inability to deliver sufficient radiofrequency energy owing to anatomical constraints, high impedance, and inadequate irrigation flow may limit the efficacy of ablation.•As a novel technique, guidewire ablation through the coronary venous system is feasible and effective for treating epicardial or intramural VA. This approach overcomes the inability to advance the traditional ablation catheter in small-diameter vessels; and compared with ethanol infusion, it is more predictable to use guidewire ablation because of accurate targeting and limited myocardial injury.•The innovation of this technique outlined in our case is the usage of a microcatheter. A guidewire covered with a microcatheter can be effectively used as an “ablation electrode” for unipolar mapping and ablation; by moving the microcatheter, length variability of the wire tip is available, as well as the possibility of performing saline infusion.