Key result
Transseptal radiofrequency ablation successfully terminates incessant VT after valve surgery with no documented recurrence.
Why the study?
Does radiofrequency catheter ablation via a transseptal approach terminate incessant VT in a patient with prosthetic tricuspid and aortic valves?
Case Report (n=1)
Does radiofrequency catheter ablation via a transseptal approach terminate incessant VT in a patient with prosthetic tricuspid and aortic valves?
Transseptal radiofrequency catheter ablation can successfully terminate incessant VT in patients with prosthetic tricuspid and aortic valves where standard access is limited.
May support transseptal access for post-valve VT when standard routes are limited; hypothesis-generating and should not yet change practice.
Sustained monomorphic ventricular tachycardia (VT) after valve surgery represents a clinical entity with different tachycardia mechanisms. This case report describes an incessant VT after tricuspid and aortic valve replacement that did not respond to antiarrhythmic drug treatment. The tachycardia exhibited VA block and a right bundle branch block pattern with left-axis deviation, suggesting ventricular excitation via the left posterior fascicle. The electrophysiological study was limited by the prosthetic tricuspid and aortic valve replacement, therefore a transseptal approach was necessary to obtain access to the ventricular myocardium. Radiofrequency catheter ablation was performed in the proximal left bundle or distal His region with termination of the incessant VT followed by complete AV block. After pacemaker implantation using a transvenous right atrial and an epicardial ventricular lead, no VT reoccurrence could be documented.
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Lewalter et al. (2002) conducted a case report in Incessant ventricular tachycardia following valve surgery (n=1). Radiofrequency catheter ablation was evaluated on Termination of incessant VT and VT reoccurrence. Radiofrequency catheter ablation via a transseptal approach successfully terminated incessant ventricular tachycardia following valve surgery, with no recurrence documented.