Author + information
- Received October 1, 2018
- Accepted October 4, 2018
- Published online January 21, 2019.
- Matthew O’Connor, MA, MB BChira,∗ (, )
- Rachel Robson, BS, MScb,
- Alyssa Kirby, MBChBa,
- Trudy Wignall, MBChBc and
- Darren A. Hooks, PhD, MBChBa,d
- aCardiology Department, Wellington Hospital, Wellington, New Zealand
- bBiosense Webster Inc., Irvine, California
- cRadiology Department, Wellington Hospital, Wellington, New Zealand
- dUniversity of Otago, Wellington, Wellington, New Zealand
- ↵∗Address for correspondence:
Dr. Matthew O’Connor, Department of Cardiology, Wellington Regional Hospital, Private Bag 7902, Wellington 6242, New Zealand.
Endocardial access to the left ventricle (LV) for catheter ablation of ventricular tachycardia is challenging when mechanical aortic and mitral valves are present. A case of ventricular transseptal access to the LV has been reported in this setting (1). This image reviews such an approach, with the novel addition of computed tomography anatomical data to facilitate safe entry into the LV at a location desirable for ablation.
Segmented computed tomography data is registered to ablation catheter location (CARTO, Biosense Webster Inc., Irvine, California) by mapping the coronary sinus and tricuspid annulus. Then, using the segmented LV endocardial volume as a target, the catheter is then placed at the desired septal puncture site (Figure 1A). Coronary angiography confirms absence of large septal perforators at the entry site (Figure 1B). Having marked the catheter location by fluoroscopy in 2 projections, the catheter is exchanged for a transseptal needle, positioned at the same site, and LV endocardial access gained with aid of transesophageal ultrasound imaging, pressure measurement, and contrast injection. Figure 1C shows the transseptal track thus formed. We prefer access via the right internal jugular vein, using a BRK-1 needle via a small curl Agilis sheath (Abbott, Chicago, Illinois). A tendency for the needle to straighten the desired transseptal path is mitigated by shaping the needle with extra bend and by flexing the sheath. In this case, transseptal access to the LV allowed mapping and ablation of an inferior scar-related ventricular tachycardia, and ultrasound showed no transseptal blood flow after withdrawal from the LV.
Ms. Robson is employed by Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received October 1, 2018.
- Accepted October 4, 2018.
- 2019 American College of Cardiology Foundation