Why the study?
In patients with mechanical aortic and mitral valves, percutaneous access to the LV for CA of VT is challenging.
This paper provides a step-by-step guide for a novel trans-right atrial to left ventricular puncture technique, enabling VT ablation in patients with both aortic and mitral mechanical valves.
Offers potential transvenous LV access for VT ablation in double mechanical valve patients; leaves open safety, durability, and generalizability.
In patients with mechanical valves in the aortic and mitral positions, percutaneous access to the left ventricle (LV) for catheter ablation (CA) of ventricular tachycardia (VT) is challenging. We have recently described a novel percutaneous trans-right atrial (RA) access to the LV via a femoral venous approach for CA of VT in patients with mechanical aortic and mitral valves. With this approach, an iatrogenic Gerbode-type of ventricular septal defect is created with direct puncture of the inferior and medial aspect of the RA anatomically adjacent to the inferior-septal LV. The technique involves the use of steerable sheaths, dedicated radiofrequency wires, and intracardiac echocardiography guidance. The procedure has been documented feasible and safe in a series of consecutive patients with aortic and mitral mechanical valves and VT related to LV substrate. In this study, the procedural details of this novel approach are described in a step-by-step fashion.
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Pasquale Santangeli (2022) studied this question.
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