Video 2. Technique for Accessing the Left Ventricle for Percutaneous Catheter Ablation of Ventricular Tachycardia in Patients With Left-Sided Mechanical Valves—Step 1.

Download video file ^{(17.6MB, mp4)}

The catheter sheath is advanced to the right atrium (RA), the dilator and wire are removed, and the sheath is deflected, applying clockwise torque to obtain contact with the inferomedial aspect of the RA adjacent to the inferior portion of the inferior-septal process of the left ventricle (ISP-LV). It is important to validate the position and angle of incidence of the distal aspect of the sheath in relation to the ISP-LV to confirm a perpendicular approach. Left panel: left anterior oblique (LAO) and right anterior oblique (RAO) fluoroscopic views; right panel: intracardiac echography view. RV indicates right ventricle.