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

作者：Hsieh Calvin H C; Thomas Stuart P; Ross David L^*

来源：Circulation-Arrhythmia and Electrophysiology, 2010, 3(2): 178-185.

DOI：10.1161/CIRCEP.109.906628

• catheter ablation
• tachyarrhythmias
• electrophysiology

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.
Methods and 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 After successful ablation, the sheaths were withdrawn and hemostasis was achieved.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. (Circ Arrhythm Electrophysiol. 2010;3:178-185.)

• 出版日期2010-4