Transseptal vs Retrograde Aortic Ventricular Entry to Reduce Systemic Emboli

Who can take part

• Men and women ≥ 18 years of age
• Planned/scheduled endocardial ventricular tachycardia (VT) or premature ventricular contraction (PVC) catheter ablation procedure
• For this patient, the current plan of the operator must be to pursue a catheter ablation target in the left ventricular endocardium that can be accessed by either a transseptal puncture or retrograde aortic approach
• Life expectancy of at least 1 year
• Willing and able to undergo pre- and post-ablation MRIs
• Willing and able to return and comply with scheduled follow up visits (through the 6 month follow-up)
• Willing and able to provide written informed consent

Who cannot take part

• Inability to perform neurocognitive function testing after > 24 hours free of sedating medications
• Current mental impairment or other diagnosis which precludes accurate assessment of neurocognitive function or which may not allow patient to understand the nature, significance and scope of the study
• Planned epicardial ablation that would include a coronary angiogram (during the index ventricular tachycardia (VT) or premature ventricular contraction (PVC) catheter ablation procedure)
• Any contraindication to MRI (as defined by the institution performing the MRI)
• Clinical contraindication to a retrograde aortic approach as determined by the treating physician, including:; Severe aortic stenosis; Mechanical aortic valve
• Clinical contraindication to a transseptal puncture as determined by the treating physician, including:; Severe Mitral valve stenosis; Mechanical Mitral valve; Atrial septal defect (ASD) or Patent foramen ovale (PFO) closure device that would preclude a transseptal puncture; Mitraclip or Alfieri mitral valve repair that would preclude a transseptal puncture
• Planned or known need to perform either a retrograde aortic approach or transseptal approach (such as to target another site during the same procedure)
• Inability to speak, read, and write in the English language at a 6th grade level (required for the Neurocognitive Function Testing)