Mechanical valves in both aortic and mitral positions pose a challenge for left ventricular (LV) access during ventricular tachycardia (VT) ablation using the antegrade transseptal or the retrograde transaortic approach. A 57 year-old male with ischemic cardiomyopathy, mechanical aortic and mitral valves, and recurrent VT underwent a combined endocardial and epicardial ablation via direct ventricular puncture via mini-thoracotomy. Successful mapping with endocardial and epicardial ablation was performed, with no recurrent VT on follow up. We showcase the feasibility of VT ablation using an open transapical approach for patients with mechanical aortic and mitral valves.

Background: In patients with non-sustained tachyarrhythmias, left ventricular (LV) systolic dysfunction is uncommon. The role of catheter ablation (CA) in asymptomatic patients with tachyarrhythmia remains unclear. Case presentation: We report a 20-year-old patient without sustained tachyarrhythmia with a left ventricular ejection fraction of 20% who underwent radiofrequency catheter ablation (RFCA) of anteroseptal accessory pathway. She achieved normalization of left ventricular systolic function noted on echocardiography performed at four weeks post-ablation. Conclusions: Our case highlights significant improvement in LV systolic function after catheter ablation of an “asymptomatic” ventricular preexcitation. Current guidelines do not endorse ablating asymptomatic patients, but careful follow up with serial echocardiograms might be warranted. Prophylactic ablation of those patients with clear evidence of LV dyssynchrony or wide left bundle branch pattern and persistent preexcitation is worth further consideration.