Percutaneous VT Ablation via RA-to-LV Access in Patients With Double Mechanical Valves: A Multicenter Registry

Background: In patients with mechanical aortic and mitral valves requiring catheter ablation of ventricular tachycardia (VT), a technique for access from the right atrium (RA) to the left ventricle (LV) via puncture of the inferoseptal process of the LV was previously described in a single-center series.

Objectives: This study sought to report the multicenter experience of VT ablation using this novel LV access approach.

Methods: We assembled a multicenter registry of patients with double mechanical valves who underwent VT ablation with RA-to-LV access.

Results: Eighteen patients from 10 VT ablation centers were included (15 men; age: 63.9 ± 10 years, LV ejection fraction: 32% ± 10%). In 14 patients, the procedure was performed on uninterrupted anticoagulation, and 4 patients underwent bridging with heparin. A mean of 2.5 VTs were inducible at procedure onset. LV access was successful in all cases with intracardiac echocardiography-guided puncture with a radiofrequency wire (n = 16) or standard transseptal needle (n = 2), followed by balloon dilation. Postablation, complete noninducibility of VT was achieved in 17 (94%) patients. One intramural perimitral annular hematoma was noted after LV access that was managed conservatively without sequelae. No other procedure-related complications were noted, such as new AV block. LV-RA shunt was present by echocardiogram within 24 to 72 hours in 10 (56%) patients. A small residual shunt was noted in 1 of them more than 3 months postablation. During the median follow-up of 10.4 months, 3 (17%) patients experienced VT recurrence.

Conclusions: In this multicenter registry of patients with double mechanical valves, VT ablation with RA-to-LV access was feasible, safe, and effective.