{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T18:54:23Z","timestamp":1781895263845,"version":"3.54.5"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"vor","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CERCA Programme\/Generalitat de Catalunya"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Catheter ablation of ventricular tachycardia (VT) in patients with both mechanical aortic and mitral valves remains challenging, as conventional retrograde or transseptal approaches are not feasible due to the risk of damaging prostheses. Alternative strategies such as thoracotomy, epicardial access, or stereotactic radiotherapy may be unsuitable due to anatomical or technical constraints. The right atrium-to-left ventricle (RA-to-LV) puncture through the inferoseptal process has recently emerged as a potential solution, yet real-world experience remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>An 81-year-old man with rheumatic heart disease, double mechanical left-sided valve replacement, chronic kidney disease, and recurrent drug-refractory VT was referred for catheter ablation. Multimodal imaging using cardiac magnetic resonance and contrast-enhanced CT processed with ADAS3D software enabled identification of the arrhythmogenic substrate in the basal lateral LV and preprocedural planning of a safe puncture trajectory. Under general anaesthesia and uninterrupted anticoagulation, a percutaneous RA-to-LV puncture was performed with real-time guidance from electroanatomical mapping, CT-fluoroscopy integration, and intracardiac echocardiography. High-density mapping revealed a basal lateral scar with areas of conduction deceleration. Targeted ablation eliminated abnormal potentials and rendered VT non-inducible. A small restrictive iatrogenic Gerbode defect was observed without haemodynamic impact at 4-month follow-up echocardiogram. The patient recovered uneventfully and remained free of VT and ICD therapies at 5-month follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case suggests that RA-to-LV access is feasible and safe in a highly selected patient when thorough multimodal planning is undertaken. This report represents the first European experience and supports the potential role of this technique in patients with no-entry ventricle.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag384","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:29:35Z","timestamp":1781612975000},"source":"Crossref","is-referenced-by-count":0,"title":["Multimodality approach to the no-entry ventricle for VT ablation: first European experience of the RA-to-LV percutaneous access\u2014a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6246-8487","authenticated-orcid":false,"given":"Javier","family":"Sana\u00fa","sequence":"first","affiliation":[{"name":"Arrhythmia Unit, Department of Cardiology, Hospital Universitari de Bellvitge, L\u2019Hospitalet de Llobregat , Carrer Feixa Llarga s\/n, Barcelona 08907 ,","place":["Spain"]},{"name":"Bioheart-Cardiovascular Diseases Group, Institut D\u2019Investigaci\u00f3 Biom\u00e8dica de Bellvitge\u2013IDIBELL, L\u2019Hospitalet de Llobregat , Avda. Gran V\u00eda de l'Hospitalet 199, Barcelona 08908 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian Rodriguez","family":"Garc\u00eda","sequence":"additional","affiliation":[{"name":"Arrhythmia Unit, Department of Cardiology, Hospital Universitari de Bellvitge, L\u2019Hospitalet de Llobregat , Carrer Feixa Llarga s\/n, Barcelona 08907 ,","place":["Spain"]},{"name":"Bioheart-Cardiovascular Diseases Group, Institut D\u2019Investigaci\u00f3 Biom\u00e8dica de Bellvitge\u2013IDIBELL, L\u2019Hospitalet de Llobregat , Avda. Gran V\u00eda de l'Hospitalet 199, Barcelona 08908 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8780-720X","authenticated-orcid":false,"given":"Josep","family":"Com\u00edn-Colet","sequence":"additional","affiliation":[{"name":"Arrhythmia Unit, Department of Cardiology, Hospital Universitari de Bellvitge, L\u2019Hospitalet de Llobregat , Carrer Feixa Llarga s\/n, Barcelona 08907 ,","place":["Spain"]},{"name":"Bioheart-Cardiovascular Diseases Group, Institut D\u2019Investigaci\u00f3 Biom\u00e8dica de Bellvitge\u2013IDIBELL, L\u2019Hospitalet de Llobregat , Avda. Gran V\u00eda de l'Hospitalet 199, Barcelona 08908 ,","place":["Spain"]},{"name":"University of Barcelona; Innovation, Research and Universities Department, Ger\u00e8ncia Territorial Metropolitana Sud, Institut Catal\u00e0 de la Salut; CIBER-CV, Gran Via de les Corts Catalanes , 585, Barcelona 08007 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6988-3487","authenticated-orcid":false,"given":"Ignasi","family":"Anguera","sequence":"additional","affiliation":[{"name":"Arrhythmia Unit, Department of Cardiology, Hospital Universitari de Bellvitge, L\u2019Hospitalet de Llobregat , Carrer Feixa Llarga s\/n, Barcelona 08907 ,","place":["Spain"]},{"name":"Bioheart-Cardiovascular Diseases Group, Institut D\u2019Investigaci\u00f3 Biom\u00e8dica de Bellvitge\u2013IDIBELL, L\u2019Hospitalet de Llobregat , Avda. Gran V\u00eda de l'Hospitalet 199, Barcelona 08908 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3561-4163","authenticated-orcid":false,"given":"Paolo Domenico","family":"Dallaglio","sequence":"additional","affiliation":[{"name":"Arrhythmia Unit, Department of Cardiology, Hospital Universitari de Bellvitge, L\u2019Hospitalet de Llobregat , Carrer Feixa Llarga s\/n, Barcelona 08907 ,","place":["Spain"]},{"name":"Bioheart-Cardiovascular Diseases Group, Institut D\u2019Investigaci\u00f3 Biom\u00e8dica de Bellvitge\u2013IDIBELL, L\u2019Hospitalet de Llobregat , Avda. Gran V\u00eda de l'Hospitalet 199, Barcelona 08908 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"2026061914151032100_ytag384-B1","first-page":"262","article-title":"Catheter entrapment in a Bj\u00f6urk-Shiley prosthesis in aortic position","volume":"13","author":"Kober","year":"1987","journal-title":"Cathet Cardiovasc Diagn"},{"key":"2026061914151032100_ytag384-B2","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1093\/eurheartj\/8.7.689","article-title":"Retrograde catheterization of left ventricle through mechanical aortic prostheses","volume":"8","author":"Rigaud","year":"1987","journal-title":"Eur Heart J"},{"key":"2026061914151032100_ytag384-B3","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.jacep.2023.10.034","article-title":"Catheter ablation of ventricular tachycardia in the presence of mechanical aortic and mitral valve replacement","volume":"10","author":"Wolfes","year":"2024","journal-title":"JACC Clin Electrophysiol"},{"key":"2026061914151032100_ytag384-B4","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCEP.116.004771","article-title":"Radiofrequency wire facilitated interventricular septal access for catheter ablation of ventricular tachycardia in a patient with aortic and mitral mechanical valves","volume":"10","author":"Santangeli","year":"2017","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2026061914151032100_ytag384-B5","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1001\/jamacardio.2020.4414","article-title":"Outcomes of percutaneous trans\u2013right atrial access to the left ventricle for catheter ablation of ventricular tachycardia in patients with mechanical aortic and mitral valves","volume":"6","author":"Santangeli","year":"2021","journal-title":"JAMA Cardiol"},{"key":"2026061914151032100_ytag384-B6","doi-asserted-by":"crossref","first-page":"2094","DOI":"10.1111\/jce.15467","article-title":"Right atrium to left ventricle puncture for VT ablation in patients with mechanical aortic and mitral valves: a step-by-step approach","volume":"33","author":"Santangeli","year":"2022","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2026061914151032100_ytag384-B7","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1016\/j.jacep.2024.10.030","article-title":"Percutaneous VT ablation via RA-to-LV access in patients with double mechanical valves","volume":"11","author":"Siontis","year":"2025","journal-title":"JACC Clin Electrophysiol"},{"key":"2026061914151032100_ytag384-B8","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1016\/j.hroo.2025.08.028","article-title":"Trans\u2013right atrial access to the left ventricle for catheter ablation of ventricular tachycardia in a patient with double left-sided mechanical valves: first case report from Latin America","volume":"6","author":"Qui\u00f1i\u00f1ir","year":"2025","journal-title":"Heart Rhythm O2"},{"key":"2026061914151032100_ytag384-B9","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1093\/ehjqcco\/qcac083","article-title":"Temporal trend analysis of rheumatic heart disease burden in high-income countries between 1990 and 2019","volume":"10","author":"Ojha","year":"2024","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"2026061914151032100_ytag384-B10","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/j.hrcr.2025.05.016","article-title":"Pre-procedural simulation of the right atrium to left ventricle puncture through the inferoseptal process using cardiac computed tomography","volume":"11","author":"Miyazaki","year":"2025","journal-title":"HeartRhythm Case Rep"}],"container-title":["European Heart Journal - 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