Novel use of preprocedure imaging for planning and guidance of right atrium–to–left ventricle access for catheter ablation of ventricular tachycardia

Abstract

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Right atrium to left ventricle puncture for VT ablation in patients with mechanical aortic and mitral valves: A step‐by‐step approach

“…A coronary angiogram can be performed to assess for proximity to the AVN artery or other significant coronary artery branches. As mentioned, preprocedural imaging with a contrast‐enhanced CT scan, although it may be helpful to define the optimal plane of access, 12 in our experience it has not been able to adequately identify small coronary artery branches around the planned site of access 10 …”

“…Since the access site crosses the ISP‐LV, an infero‐septal substrate may be more challenging to target (see below). On the other hand, owing to substantial artifacts related to the presence of the mechanical valves, the most basal myocardial segments may not be well characterized by preprocedural CMR or CT. More recently, three‐dimensional anatomical reconstruction of the cardiac chambers from contrast‐enhanced CT has been reported useful to plan the site of puncture and guide the procedure 12 . Additional potential benefits of preprocedural imaging may be the delineation of the course of the coronary arteries (particularly of the atrio‐ventricular nodal artery) and their relationship with the planned site of access.…”

“…On the other hand, owing to substantial artifacts related to the presence of the mechanical valves, the most basal myocardial segments may not be well characterized by preprocedural CMR or CT. More recently, three-dimensional anatomical reconstruction of the cardiac chambers from contrast-enhanced CT has been reported useful to plan the site of puncture and guide the procedure. 12 Additional potential benefits of preprocedural imaging may be the delineation of the course of the coronary arteries (particularly of the atrio-ventricular nodal artery) and their relationship with the planned site of access. However, in our experience contrast-enhanced CT is not able to adequately visualize small coronary branches around the ISP-LV region, 10 also due to artifacts from the nearby mechanical valves.…”