Intramyocardial radiofrequency ablation of ventricular arrhythmias using intracoronary wire mapping and a coronary reentry system: Description of a novel technique

Key Teaching Points • Ventricular arrhythmias originating from the left ventricular summit and intramyocardially within the interventricular septum pose a serious challenge to catheter ablation, as myocardial thickness, epicardial fat, and coronary vessels impede appropriate radiofrequency energy delivery. • Intracoronary mapping and subsequent intramyocardial ablation using radiofrequency ablation delivered through a system routinely used to treat coronary artery chronic total occlusions (ie, Stingray LP Coronary CTO Re-Entry System) is feasible and effective. • Unlike alcohol injection and coil embolization of septal perforator arteries, intramyocardial RF ablation using this technique is a more localized and limited approach with less risk of complete atrioventricular block and less myocardial injury.