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 third step of the technique. After confirming position and angle of incidence of the distal aspect of the catheter sheath, puncturing the ISP-LV from the RA with 15 W to 25 W of radiofrequency (RF) energy, and advancing the RF wire to the LV apex, the RF wire is exchanged with a stiffer Amplatz wire by advancing a hydrophilic 4F microcatheter over the RF wire inside the LV, keeping the tip of the deflectable sheath in contact with the RA site of access. With the microcatheter advanced in the LV over the RF wire, the RF wire is exchanged with the stiffer Amplatz wire. 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 fluoroscopic view. Right panel: intracardiac echography view.
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