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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 video shows the first step of the technique. The catheter sheath is advanced to the RA, the dilator and wire are removed, and the sheath is deflected, applying clockwise torque to obtain contact with the inferomedial aspect of the RA adjacent to the inferior portion of the ISP-LV. It is important to validate the position and angle of incidence of the distal aspect of the sheath in relation to the ISP-LV to confirm a perpendicular approach. 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 additional steps of the technique. Left panel: left anterior oblique (LAO) and right anterior oblique (RAO) fluoroscopic views. Right panel: intracardiac echography view. RV indicates right ventricle.
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