Retrograde aortic access during ventricular tachycardia ablation: Indications, techniques, and challenges

Area of Science:

• Cardiology
• Electrophysiology
• Interventional Cardiology

Background:

• The retrograde aortic (RA) route is a common approach for left ventricular endocardial ventricular tachycardia (VT) mapping and ablation.
• VT ablation is increasingly used in patients with comorbidities, making the choice between RA and transseptal access crucial.

Purpose of the Study:

• To review patient selection criteria for RA access in VT ablation.
• To discuss potential complications and optimal techniques for RA access, particularly in patients with challenging anatomy.

Main Methods:

• Literature review focusing on retrograde aortic access for VT ablation.
• Analysis of techniques used in structural interventions applicable to challenging vascular or aortic valve anatomy.

Main Results:

• Individualized decisions for RA access depend on substrate location, vascular anatomy, aortic valve morphology, and operator experience.
• Insights from transcatheter aortic valve replacement and peripheral vascular interventions inform safe retrograde access techniques.

Conclusions:

• Optimal retrograde aortic access requires careful patient selection and consideration of complex anatomical factors.
• Experience from structural interventions enhances safety and efficacy of RA access in challenging VT ablation cases.