Direct transthoracic access to the left ventricle for catheter ablation of ventricular tachycardia

Circulation. Arrhythmia and Electrophysiology
Calvin H C HsiehDavid L Ross

Abstract

Percutaneous approaches for radiofrequency ablation of ventricular tachycardia (VT) in the left ventricle are typically transarterial retro-aortic, antegrade transmitral via an interatrial septal puncture, or epicardial. However, all 3 approaches may be contraindicated in certain cases. We describe 2 cases of VT ablation in which aortic and mitral valve replacements did not permit utilization of any of these techniques. Direct access to the left ventricular cavity was achieved with a percutaneous puncture through the intercostal space overlying the apex in the first case and through a left minithoracotomy in the second. A sheath was then inserted via the Seldinger technique, allowing catheter access for mapping and ablation of the VT. After successful ablation, the sheaths were withdrawn and hemostasis was achieved. A large left hemothorax occurred from the left ventricular apical puncture in the first case. Direct closure with a purse-string suture in the second case achieved hemostasis. Direct percutaneous left ventricular puncture is a viable option for mapping and ablation of left ventricular VT. A minithoracotomy allows better hemostatic control. This technique has a role when other percutaneous approaches are contraindica...Continue Reading

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Citations

Jul 26, 2014·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Tilko ReentsIsabel Deisenhofer
May 7, 2013·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Marmar VaseghiKalyanam Shivkumar
Jan 15, 2011·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Israel M BarbashRobert J Lederman
Jul 12, 2013·Interactive Cardiovascular and Thoracic Surgery·Henriette BrinksChristoph Huber
Apr 16, 2018·Pacing and Clinical Electrophysiology : PACE·Ozcan OzekeDursun Aras
Apr 23, 2015·Circulation. Arrhythmia and Electrophysiology·Tomas KonecnySiva K Mulpuru
Feb 27, 2015·Circulation. Arrhythmia and Electrophysiology·Kyoko SoejimaHideaki Yoshino
Oct 13, 2017·Pacing and Clinical Electrophysiology : PACE·Veysel Kutay VurgunOmer Akyurek

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