RV-LV
RV-LV approach is used when there is a significant septal distribution of the myocardial scar. To evaluate the scar location and to plan the procedure, short axis stacks of LGE CMR or 4D multiphasic CT scan are used. Both location and extension of the scar are assessed in order to plan anchor placement and the number of needed devices. The internal anchor and the corresponding external anchor pair are the first ones to be implanted. Then, if more scar is identified basally to this pair, a second external anchor pair is applied in this location. This anchor pair can exclude a portion of septal scar as well, sacrificing a small portion of the right ventricle – this is nicknamed the “Antonius stitch”, after the development of this modification at the St. Antonius Hospital, Nieuwegein, The Netherlands (a hospital with extensive experience with the LIVE procedure) (Figure 5 ). Finally, the apical component is treated with LV-LV anchor pairs. If the scar doesn’t affect the entire apical circumference, anchor placement can be tailored to exclude only the non-viable segments.