LAUSR

Catheter ablation (CA) is an important treatment option for patients with ischemic heart disease presenting with ventricular tachycardia (VT).1, 2 Various CA techniques are currently available, including remote magnetic navigation (RMN)–guided ablation.2 Most published studies reported superiority of RMN-guided VT ablation over manual ablation, with respect to acute success, recurrence, procedure time, fluoroscopy time, and complications.3, 4, 5 The RMN system (Niobe Epoch, Stereotaxis Inc, St. Louis, MO) uses 2 permanent magnets mounted on pivoting arms, 1 magnet on either side of the patient, which creates a computer-controlled steerable magnetic field to remotely guide the movement of a magnetically enabled ablation catheter.6 Unfortunately, many VTs are not suitable for mapping during VT ablation, mostly because of their hemodynamic instability.7 It is well known that hemodynamically unstable VT might be successfully ablated with the aid of mechanical circulatory support (MCS), using a variety of devices.8, 9, 10 However, most of the currently available continuous-flow MCS devices operate using a metal pump as core of the technology, which limits their use in a magnetic environment. The risk of electromagnetic interference has resulted in restraint in the use of percutaneous continuous-flow MCS during RMN-guided VT ablation.11, 12 This would be a major limitation, especially in centers with a preference for RMN-guided VT ablation. For the first time, we report a case in which, with careful planning, RMN-guided VT ablation was successfully combined with hemodynamic support using the Impella continuous-flow MCS (Abiomed Inc, Danvers, MA).