Catheter Ablation of Ventricular Tachycardia in the Presence of an Old Endocavitary Thrombus Guided by Intracardiac Echocardiography.
BACKGROUND
Catheter ablation of ventricular tachycardia (VT) in patients with structural heart disease (SHD) is effective in prevention of arrhythmia recurrences. However, endocardial ablation may be challenging in the presence of organized left ventricular (LV) endocavitary thrombus. Our goal was to analyze the results of VT ablation in patients with identified old thrombus.


METHODS AND RESULTS
We reviewed clinical and procedural data of 344 consecutive patients who underwent VT ablation for SHD. Old endocavitary thrombus was identified in four patients by preprocedural transthoracic echocardiography (TTE) and in four more patients by intracardiac echocardiography (ICE). All together, the case series of eight patients with detectable thrombus is reported. All patients (one woman, age: 67 ± 7 years) had postinfarction aneurysm (20 ± 8 years after the index myocardial infarction) and the thrombus was well organized without mobile structures. Arrhythmogenic substrate could not be obviously targeted beneath the base of thrombus; however, catheter ablation was successfully performed in the close vicinity. A total of 2.4 ± 1.2 procedures were necessary to abolish VT recurrences. Epicardial ablation was performed in three of eight (38%) patients as a second elective procedure. No procedural or periprocedural complications were observed. During the follow-up of 14 ± 15 months, two patients (25%) had sporadic VT recurrences.


CONCLUSIONS
ICE seems to be more sensitive for the detection of LV thrombi compared to TTE and is helpful in real-time navigation of mapping/ablation catheter. Besides potential thromboembolic risk, large thrombus may prevent accessibility to the "critical" portion of arrhythmia circuit and epicardial ablation is required in selected cases.
['Peichl|Petr|P|', 'Wichterle|Dan|D|', 'Čihák|Robert|R|', 'Aldhoon|Bashar|B|', 'Kautzner|Josef|J|']
D000368:Aged D006348:Cardiac Surgical Procedures D017115:Catheter Ablation D004452:Echocardiography D005260:Female D006331:Heart Diseases D006801:Humans D008297:Male D012189:Retrospective Studies D025321:Surgery, Computer-Assisted D017180:Tachycardia, Ventricular D013927:Thrombosis D013997:Time Factors
catheter ablation ventricular tachycardia thrombus