Abstract
Combined endocardial and epicardial ablation of drug-refractory ventricular tachycardia by direct ventricular puncture
Highlights
Mechanical heart valves in both aortic and mitral positions pose a significant challenge for left ventricular (LV) access during ventricular tachycardia (VT) ablation using the standard antegrade transseptal or the retrograde transaortic approach
Patients with drug-refractory VT and double mechanical valve prostheses present a unique challenge in that conventional percutaneous LV access via antegrade transseptal or retrograde aortic approach is not possible
The epicardial approach may not be optimal given the endocardial location of reentrant circuits, which occurs commonly in ischemic cardiomyopathies, which may decrease the efficacy of isolated epicardial ablations that do not extend deep enough to the endocardial surface to alter the arrhythmogenic substrate
Summary
Mechanical heart valves in both aortic and mitral positions pose a significant challenge for left ventricular (LV) access during ventricular tachycardia (VT) ablation using the standard antegrade transseptal or the retrograde transaortic approach. The customary approaches are not possible because of risk of catheter entrapment and death, and alternative strategies are necessary.
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