Successful Radiofrequency Catheter Ablation of Parahisian Ventricular Tachycardia using Remote Magnetic Navigation and an Open Irrigation Catheter : An Initial Case Series

Radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) found to be in a parahisian (PH) location may be challenging when using a manual technique. We present an initial case series illustrating the safety and efficacy of RFCA of PH VT using remote magnetic navigation (RMN) and an open irrigation catheter (OIC). Conventional electrophysiology study (EPS) with baseline cardiac intervals was performed. A RMT OIC (Biosense Webster) was used for stereotactic mapping and ablation. The His bundle was identified and tagged for reference on the ablation map. Pace mapping (PM) with correlation to template VT was performed to identify the area of VT origin. RFCA was performed in power control mode at 40 W for 30-s lesions. Both patients received radiofrequency ablation of VT in a PH location without significant prolongation of AH or HV intervals, or signs of heart block. There was no recurrence of template VT in either patient. The use of RMN and an OIC is safe and effective for ablation of VT in a PH location. RMN allows greater catheter manipulation and stability. The OIC permits higher ablation powers.