Two Cases of Ventricular Tachycardia Originating from Left Ventricle Successfully Ablated Using the Transseptal Approach

Abstract

We describe two cases of ventricular tachycardia (VT) originating from the left ventricle (LV) successfully ablated using the transseptal approach. In both cases, electroanatomical voltage and activation and conventional mapping identified the origin of the VT. Case 1 was an 81 year-old-male who had undergone a Bentall operation due to aortic valve regurgitation. The origin of the VT was identified in the low voltage zone (LVZ) of the basal lateral wall of the LV. Linear ablation of the LVZ brought deceleration and non-sustenance of VT. The patient was free of VT for 2 years. Case 2 was an 81 year-old male who had a history of old cerebral infarction complicated with percutaneous coronary intervention for inferior myocardial infarction. The origin of the VT was identified in the LVZ of the inferior wall of the LV. After linear ablation of the LVZ, VT became non-inducible. The patient was free of VT for 3 years. Summary : In cases of VT originating from the left ventricular endocardium where the retrograde transaortic route is contraindicated or difficult to approach through the transseptal approach is a useful strategy of VT ablation, especially in VT originating from the lateral or inferior wall of left ventricle. If a guiding sheath is suitable for accessing the LV, the whole LV can be mapped as with the transaortic approach.