Zero-Fluoroscopy Ablation of Epicardial Focal Atrial Tachycardia Via the Pulmonary Artery

BACKGROUND: Focal atrial tachycardia represents a common form of arrhythmia. In a subset of cases, the arrhythmogenic focus may originate from epicardial structures, which can render endocardial ablation ineffective. CASE SUMMARY: A 55-year-old man presented with progressive palpitations over several weeks. He had no significant prior cardiac history. During the ablation procedure, a focal atrial tachycardia refractory to conventional endocardial ablation was identified. The arrhythmia was successfully eliminated through adjunctive ablation performed within the right pulmonary artery. DISCUSSION: A zero fluoroscopy transpulmonary arterial approach is feasible for ablating an epicardial atrial tachycardia, highlighting it as a viable alternative when conventional endocardial ablation fails. TAKE-HOME MASSAGES: Indirect epicardial intervention targeting the left atrium via adjacent anatomical pathways has been demonstrated to be both safe and feasible in selected cases. The performance of ablation procedures necessitates advanced catheter manipulation and can be effectively guided and localized in real time using intracardiac echocardiography.