Right atrium to left ventricle puncture for VT ablation in patients with mechanical aortic and mitral valves: A step-by-step approach

J Cardiovasc Electrophysiol. 2022 Sep;33(9):2094-2099. doi: 10.1111/jce.15467. Epub 2022 Apr 2.

Abstract

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.

Keywords: catheter ablation; double mechanical valves; iatrogenic Gerbode defect; ventricular tachycardia.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Catheter Ablation* / adverse effects
  • Catheter Ablation* / methods
  • Heart Atria
  • Heart Ventricles
  • Humans
  • Mitral Valve / diagnostic imaging
  • Mitral Valve / surgery
  • Punctures
  • Tachycardia, Ventricular* / diagnostic imaging
  • Tachycardia, Ventricular* / surgery