Remote Magnetic Navigation for Catheter Ablation of Epicardial Arrhythmias in Patients with Structurally Normal Heart.

Remote magnetic navigation (RMN) presents a promising approach for catheter ablation in complex arrhythmias. This study aims to offer additional insights into the feasibility, safety, and efficacy of RMN for catheter ablation of epicardial atrial and ventricular arrhythmias in patients without structural heart disease. We present a case series of three patients (39-year-old female, 28-year-old female, and 17-year-old male) referred to our institute for epicardial ablation following unsuccessful endocardial procedures. The first patient exhibited approximately 40,000 monomorphic premature ventricular complexes (PVCs) in a 24-hour Holter recording, while the second patient experienced incessant left ventricular tachycardia (VT). In both cases, the QRS morphology indicated an epicardial origin of the arrhythmia. The third patient suffered from incessant atrial tachycardia (AT) originating from the distal portion of the vein of Marshall (VOM). Epicardial 3D electroanatomic mapping and ablation with RMN were performed with ease and minimal fluoroscopy usage. Coronary angiogram visualization on the RMN screen provided real-time information on the catheter tip's position relative to the coronary arteries. In all cases, the earliest signals were recorded epicardially, and unipolar recordings displayed sharp negative deflections at the sites of successful ablation. In the first patient, pace mapping was superior in the epicardium compared to the endocardium, and PVCs were eradicated by epicardial ablation. In the second patient, epicardial ablation immediately terminated the VT. In the third patient, epicardial ablation at the site exhibiting a distinct VOM potential promptly terminated the AT. No perioperative complications were observed, and all patients remained asymptomatic and free of arrhythmias during long-term follow-up. Our findings suggest that RMN is a feasible, effective, and safe approach for epicardial ablation of left ventricular outflow tract PVCs and VT, as well as atrial tachycardia originating from the VOM. [ABSTRACT FROM AUTHOR]