title: Surgical catheter ablation of ventricular tachycardia using left thoracotomy in a patient with hindered access to the left ventricle.
abstract: We report the case of a patient presenting with incessant monomorphic ventricular tachycardia resistant to antiarrhythmic drugs, and in whom usual percutaneous vascular or pericardial access to the left ventricle was hindered by mechanical aortic and mitral prosthetic valves. Because an epicardial location was suspected by electrocardiogram features and because access to the target area through the coronary sinus was not possible, we decided to perform a surgically based radiofrequency (RF) ablation. Catheter mapping of the epicardial surface through surgical left lateral thoracotomy in the operating room confirmed the epicardial location of the arrhythmogenic substrate and allowed successful RF ablation of the clinically incessant tachycardia. Combined surgical and electrophysiological approach should therefore be performed when RF ablation is needed in case of unadvisable, difficult, or failed nonsurgical percutaneous access.
authors.affiliation: Federation of Cardiology, University Hospital Rangueil, Toulouse, France. mauryjphil@hotmail.com
authors.forename: Philippe
authors.initials: P
authors.lastname: Maury
authors.forename: Bertrand
authors.initials: B
authors.lastname: Marcheix
authors.forename: Alexandre
authors.initials: A
authors.lastname: Duparc
authors.forename: Aurélien
authors.initials: A
authors.lastname: Hébrard
authors.forename: Caroline
authors.initials: C
authors.lastname: Paquie
authors.forename: Pierre
authors.initials: P
authors.lastname: Mondoly
authors.forename: Anne
authors.initials: A
authors.lastname: Rollin
authors.forename: Marc
authors.initials: M
authors.lastname: Delay