In patients with combined mitral and aortic mechanical values and recurrent VT related to diseased LV substrate, traditional retrograde aortic or antegrade transmitral LV access approaches for catheter ablation are impossible. Researchers have developed a novel technique to access the LV via direct puncture of the inferior-septal process of the LV (ISP-LV) from the adjacent right atrium (RA) in these patients. This dedicated 3-chamber intracardiac echography video demonstrates the optimal site to access the LV from the RA: the inferoseptal RA adjacent to the most inferior portion of the ISP-LV at the level of the inferior third of the coronary sinus ostium. Click the Related Article link for complete details of the procedure and outcomes in a case series of patients and related video links for illustrations of each step of the technique. RV indicates right ventricle; TV, septal leaflet of the tricuspid valve.
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