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.