RA-to-LV percutaneous access for VT ablation was feasible and safe in a patient with double mechanical left-sided valves, resulting in freedom from VT at 5-month follow-up.
Case Report (n=1)
Is percutaneous RA-to-LV access feasible and safe for VT ablation in a patient with double mechanical left-sided valves?
RA-to-LV access for VT ablation is feasible and safe in highly selected patients with mechanical aortic and mitral valves when guided by thorough multimodal imaging.
Abstract Background Catheter ablation of ventricular tachycardia (VT) in patients with both mechanical aortic and mitral valves remains challenging, as conventional retrograde or transseptal approaches are not feasible due to the risk of damaging prostheses. Alternative strategies such as thoracotomy, epicardial access, or stereotactic radiotherapy may be unsuitable due to anatomical or technical constraints. The right atrium-to-left ventricle (RA-to-LV) puncture through the inferoseptal process (ISP) has recently emerged as a potential solution, yet real-world experience remains limited. Case summary An 81-year-old man with rheumatic heart disease, double mechanical left-sided valve replacement, chronic kidney disease, and recurrent drug-refractory VT was referred for catheter ablation. Multimodal imaging using cardiac magnetic resonance (CMR) and contrast-enhanced CT processed with ADAS3D software enabled identification of the arrhythmogenic substrate in the basal lateral LV and preprocedural planning of a safe puncture trajectory. Under general anaesthesia and uninterrupted anticoagulation, a percutaneous RA-to-LV puncture was performed with real-time guidance from electroanatomical mapping, CT-fluoroscopy integration and intracardiac echocardiography (ICE). High-density mapping revealed a basal lateral scar with areas of conduction deceleration. Targeted ablation eliminated abnormal potentials and rendered VT non-inducible. A small restrictive iatrogenic Gerbode defect was observed without hemodynamic impact at 4-month follow-up echocardiogram. The patient recovered uneventfully and remained free of VT and ICD therapies at 5-month follow-up. Discussion This case suggests that RA-to-LV access is feasible and safe in a highly selected patient when thorough multimodal planning is undertaken. This report represents the first European experience and supports the potential role of this technique in patients with no-entry ventricle.
Sanaú et al. (Tue,) conducted a case report in Recurrent drug-refractory ventricular tachycardia (n=1). RA-to-LV percutaneous access for VT ablation was evaluated on Freedom from VT and ICD therapies. RA-to-LV percutaneous access for VT ablation was feasible and safe in a patient with double mechanical left-sided valves, resulting in freedom from VT at 5-month follow-up.
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