Epicardial access and ventricular tachycardia ablation in a postmyocarditis patient using a nonfluoroscopic catheter visualization system

Introduction The efficacy of catheter ablation for scar-related ventricular tachycardia (VT) has significantly improved since the introduction of percutaneous epicardial access by Sosa in 1996. Percutaneous epicardial ablation has been used in approximately 30% of VT ablation cases associated with nonischemic cardiomyopathy. However, complications such as cardiac tamponade, coronary artery laceration, or occlusion develop in approximately 4% of the procedures. Epicardial puncture and ablation are indicated after coronary angiogram (CAG) so as to avoid damage to the coronary arteries. Prior to the ablation, a CAG must be repeated, and fluoroscopy is often used during the puncture while the operator’s hands are in the field. As a result, these procedures increase fluoroscopy time and radiation exposure for both the patient and the operator. MediGuide (St. Jude Medical [SJM], St. Paul, MN) is a sensor-based, electromagnetic, nonfluoroscopic catheter visualization system. The system tracks dedicated sensorembedded catheters and guidewires directly on fluoroscopy or cine-loop images acquired at the beginning of the ablation procedure. To reduce radiation exposure during the access and mapping, the MediGuide system has been used for epicardial access and ablation in our institution. In this report, we present a patient with postmyocarditis scar-related VT who underwent an ablation procedure using this technology.