Direct Transthoracic Access to the Left Ventricle for Catheter Ablation of Ventricular Tachycardia

Hsieh, C.; Thomas, Stuart P.; Ross, David L.

doi:10.1161/circep.109.906628

Cited by 27 publications

(25 citation statements)

References 12 publications

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“…Hsieh et al 7 reported 2 cases in which direct percutaneous LV puncture and catheter ablation were used effectively to treat scar-related VT in patients with prosthetic aortic and mitral valves. Hemorrhage into the left pleural space occurred in the first case and was prevented in the second by using a minithoracotomy and pursestring ties to control bleeding from the LV puncture site.…”

Section: Discussionmentioning

confidence: 99%

Options for ventricular tachycardia ablation after double valve replacement

Baldinger

Kumar

Enriquez

et al. 2015

HeartRhythm Case Reports

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Section: Discussionmentioning

confidence: 99%

Options for ventricular tachycardia ablation after double valve replacement

Baldinger

Kumar

Enriquez

et al. 2015

HeartRhythm Case Reports

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“…13, 14 Hsieh et al described catheter ablation of VT using this technique. 15 However, trans-apical approaches carry a high risk of bleeding and other major and minor complications, ranging from 8 to 40%. These risks include pericardial bleeding, pneumothorax, hypotension, and injury to intercostal vessels or coronary arteries.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous interventricular septal access in a patient with aortic and mitral mechanical valves: A novel technique for catheter ablation of ventricular tachycardia

Vaseghi¹,

Macias²,

Tung³

et al. 2013

Heart Rhythm

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IntroductionCatheter ablation of ventricular tachycardia (VT) is typically performed using either the atrial transseptal approach or a retrograde aortic approach in order to gain access to the left ventricle (LV). However, neither approach is feasible in the setting of mechanical aortic and mitral valve replacements, given the risk of catheter entrapment and death. 1, 2 Therefore, approaches that avoid traversing these valves, such as a percutaneous trans-apical approach, have been developed. [3][4][5][6] However, the trans-apical approach is associated with a significant rate of access related complications, particularly bleeding at the puncture site, and necessitates the placement of closure devices in the LV. 7,8 We describe a novel percutaneous inter-ventricular transseptal puncture technique and placement of a sheath across the inter-ventricular septum for catheter ablation of VT. This method allowed for stable LV access and spontaneous closure of the septal access site. Case Report Clinical HistoryA 35-year-old male was referred to our center for catheter ablation of recurrent VT requiring multiple implantable cardiac defibrillator (ICD) therapies. He had undergone mechanical aortic and mitral valve replacements after developing endocarditis due to a dental abscess. Five years later, he suffered from sudden cardiac arrest and a single-lead ICD was placed. His ejection fraction was estimated at 35% and Q waves were noted on the ECG in the inferior leads. He subsequently suffered from VT storm with increasing number of ICD shocks and anti-tachycardia pace terminated (ATP) episodes despite therapy with sotalol and © 2013 The Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.Address for correspondence: Kalyanam Shivkumar, M.D., Ph.D., FHRS, UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Suite # 660, Los Angeles, CA 90095, 310-206-2235 (phone), 310-825 4251 (Fax), kshivkumar@mednet.ucla.edu. Disclosure: The Regents of the University of California, Los Angeles has intellectual property developed by the author (KS) that relate to data reported in this paper.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. amiodarone, and also developed trans-aminitis secondary to amiodarone. In the past year, he had suffered from 110 episodes of VT requiring either ATP or ICD shocks and was highly symptomatic, even during the ATP episodes. Given the presence of mechanical prostheses in the mitral and aortic valve positions, a novel method of LV access across the interventricular septum was discussed wi...

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“…Prior groups have reported this technique in adults with prosthetic mitral and aortic valves, 1 but its feasibility at this age was never tested before.…”

Section: Commentsmentioning

confidence: 99%