Guidewire-Assisted 3D Mapping of Intramural Ventricular Arrhythmia Associated with Roemheld Syndrome: A Novel Case Report

Background Intramural PVCs (premature ventricular complexes) can be challenging to treat due to the deep origin within the myocardium. Case Summary A 45-year-old female with frequent palpitations triggered by abdominal pain was found to have a 24% PVC burden over 24 hours and preserved LVEF (left ventricular ejection fraction). An electrophysiology study and 3D electroanatomical mapping showed features of intramural PVCs. The coronary venous system was further mapped using VisionWire (0.014-inch). Catheter ablation at the basal right ventricular septum led to PVC suppression with non-inducibility of the clinical PVC at the end of the case. Conclusion The use of multimodality mapping and ablation tool has enabled us to manage cases effectively with good clinical outcomes. Roemheld syndrome is an understudied diagnosis and forgotten entity that can lead to PVCs via vagus nerve mediated mechanism.