Catheter ablation via the brachial artery is a feasible alternative for treating ventricular arrhythmias originating from the right coronary cusp when femoral access is precluded by tortuous iliac arteries.
Brachial access may enable ablation when femoral routes fail; hypothesis-generating and should not yet change practice.
We described a case of a 72-year-old man with frequent premature ventricular contractions (PVC) and recurrent ventricular tachycardia (VT). Multiple anti-arrhythmic medications had failed to relieve symptoms. It was decided to treat the PVC/VT with catheter ablation. Mapping was first attempted in the right ventricle and ablation failed to eliminate PVC. In view of the possible left-sided origin, a 7F arterial sheath was inserted through the right femoral artery. However, the catheter could not be passed through the right iliac artery which appeared tortuous judged from the shape of the guide wire running through it. The same problem was encountered when using the left femoral artery. Considering PVC most likely originated from the coronary cusp based on QRS complex morphology, we chose to perform ablation via the right brachial artery. A 7F ablating catheter was smoothly inserted through the right brachial artery. In activation sequence mapping, the earliest activated site was located in the right coronary cusp. A RF application resulted in PVC elimination. To our knowledge, this is the first report of ablation through the brachial artery of ventricular arrhythmia originating from the right coronary cusp. The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/Documents/Catheter_ablation_via_the_brachial_artery.pdf.
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Han et al. (2015) studied this question.