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


RESULTS
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 After successful ablation, the sheaths were withdrawn and hemostasis was achieved.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.


CONCLUSIONS
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 contraindicated.
University of Sydney, New South Wales, Australia, and Westmead Hospital, Sydney, New South Wales 2145, Australia.
Calvin H C
CH
Hsieh
Stuart P
SP
Thomas
David L
DL
Ross
D000368:Aged; D001021:Aortic Valve; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D006350:Heart Valve Prosthesis; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D008943:Mitral Valve; D017180:Tachycardia, Ventricular / Q000503:physiopathology / Q000601:surgery*; D013908:Thoracotomy / Q000379:methods*