Successful ventricular tachycardia ablation in a patient with limited vascular and left ventricular endocardial access due to multiple mechanical cardiac support devices.

A 48-year-old male with ischemic cardiomyopathy was admitted because of cardiogenic shock due to incessant ventricular tachycardia (VT). Despite the introduction of multiple mechanical cardiac support (MCS) devices, his hemodynamics were unstable; therefore, VT ablation was performed. Due to the limited vascular and left ventricle (LV) access with the multiple MCS devices, only the left femoral artery and vein were accessible. In addition, the transseptal approach as an LV access was difficult because of the MitraClip (Abbott Park, IL, USA). Posterior papillary muscle-origin VT was successfully treated via a transaortic approach under the MCS. After the VT ablation, the patient recovered from the MCS.

Learning objective: Mechanical cardiac support (MCS) devices are critical during ventricular tachycardia (VT) ablation in patients with left ventricular (LV) dysfunction. However, the ablation strategy for cases with limited access due to multiple MCS devices has not been established. In this case, VT was successfully treated via a transaortic approach using intracardiac echocardiography. The number of cases requiring VT ablation for patients with limited vascular and LV endocardial access would increase; therefore, the accumulation of those cases is required to find a better strategy.