Technique for Accessing the Left Ventricle (LV) for Percutaneous Catheter Ablation of Ventricular Tachycardia (VT) in Patients With Left-Sided Mechanical Valves—Step 2

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 second step of the technique. After validating the position and angle of incidence of the distal aspect of the catheter sheath in relation to the ISP-LV to confirm a perpendicular approach, the ISP-LV is punctured from the RA with a dedicated radiofrequency (RF) wire delivering 15 W to 25 W of RF energy for 4 to 5 seconds. Validation of LV access is performed via direct visualization of the wire entering the LV from the ISP-LV as well as imaging of LV “bubbles” associated with RF application. The wire is then advanced to the LV apex. 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: right anterior oblique (RAO) fluoroscopic view. Right panel: intracardiac echography view.