Guidewire ablation for epicardial ventricular premature beats: A case report

Guidewire ablation for epicardial ventricular premature beats: A case reportTo the Editor, Premature ventricular complexes (PVCs) arising from the great cardiac vein (GCV)was rare, which in all PVC patients scheduled for catheter ablation of idiopathic PVCs.1,2 However, catheter ablation of PVCs originating from the distal GCV is not an easy task.We report a case of PVCs originating from the left ventricular summit were successfully ablated from the distal part of the GCV using a guidewire.A 60-year-old man with palpitations for 1 month.Electrocardiogram (ECG) showed frequent PVCs (Fig. 1A).The clinical ECG showed that the PVC an epicardial origin in the left ventricular summit region.3 A 24-h ambulatory Holter ECG showed that the number of PVCs was 39,923 in 24 hours.3D electroanatomic mapping (Carto-3; Biosense Webster) was used for activation mapping.On the endocardial of the Summit region, a target site with a local potential preceding the surface QRS by 30 ms was identified.Radiofrequency ablation was initially effective but recurred shortly.The ablation catheter was advanced into the CVS, but unfortunately, we ultimately failed despite many attempts.A 0.014inch angioplasty guidewire was advanced into the coronary sinus via a guiding catheter, then a microcatheter was advanced over the wire to expose only the distal 25 mm of the tip for mapping.We connected the proximal end of the guidewire to the ablation catheter for the recording of the unipolar signal, and a near-field potential by wire that preceded the QRS by 25 ms at the distal part of the GCV was identified (Fig. 1B).We advanced the guidewire and withdrew the microcatheter, leaving approximately 15mm of wire tip exposed for ablation.During the ablation procedure, RF energy was delivered with a starting output of 15 W for 30 seconds; The PVCs disappeared immediately 3 seconds later.The patient remained asymptomatic at 12 months, with no PVCs recurrence on Holter monitoring.