Guidewire Ablation via Coronary Venous System for Frequent VPBs: A Case Report

Ventricular arrhythmias originating from the left ventricular summit (LVS) are challenging to treat with conventional catheter ablation due to the region's complex anatomy, proximity to coronary arteries, and epicardial fat coverage. Percutaneous guidewire ablation via the coronary venous system (CVS) provides a minimally invasive therapeutic option for refractory arrhythmias in this area.

Herein, we present the case of a 60-year-old Asian female patient who had a 1-year history of palpitations and was diagnosed with symptomatic, frequent ventricular premature beats (VPBs). The patient exhibited an inadequate response to metoprolol and amiodarone as pharmacological therapy and conventional ablation approaches. Following guidewire ablation via the CVS, the VPBs were eliminated entirely, her palpitations fully resolved, and no procedure-related complications, such as coronary artery injury or thrombosis, were observed. During follow-up, there was no recurrence of VPBs, and left ventricular function remained normal.

By employing precise mapping, individualized parameter settings, and strict safety monitoring, percutaneous guidewire ablation via the CVS can effectively treat drug-refractory VPBs originating from the LVS. Importantly, this approach could serve as a complementary option when traditional ablation methods are unsuccessful, offering a feasible therapeutic strategy for complex ventricular arrhythmias.