Fluoroscopy-guided transatrial access to the left ventricle for ventricular tachycardia ablation in a patient with dual mechanical valves

Performing catheter ablation of ventricular tachycardia (VT) in patients who have both mechanical aortic and mitral valves presents a significant technical challenge because conventional routes (transaortic and transseptal) are not possible. Recently, intentional creation of a right atrium (RA) to left ventricle (LV) access route, mimicking a Gerbode-type defect, has emerged as a feasible alternative in this rare scenario.1,2 Gerbode defects themselves are typically congenital or postoperative3 or may develop in the setting of infective endocarditis.