Catheter Ablation of Ventricular Tachycardia in Patients With MitraClip Device: Preliminary Findings

LM Haegeli, G D'Angelo, N Trevisi, Stefano Stella, A Breitenstein, F Duru, C Brunckhorst, P Della Bella

Research output: Contribution to journalArticle

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Abstract

VT Ablation in MitraClip Patients: Introduction: Patients with mitral regurgitation are increasingly treated by percutaneous implantation of a MitraClip device (Abbott Park, IL, USA). We investigate the feasibility and safety of the transmitral catheter route for catheter ablation of ventricular tachycardia (VT) in these patients. Methods: The mitral valve with the MitraClip in situ was crossed under transesophageal 3-dimensional echocardiographic and fluoroscopic guidance using a steerable sheath for ablation of the left ventricle. Results: Five patients (all males, median age 74.0 ± 16.0 years) who had previously a MitraClip implanted were referred for catheter ablation of VT. The left ventricular ejection fraction was 29.0% ± 24.0%. One patient had both an atrial septal defect and a left atrial appendage occluder device in addition to a MitraClip. The duration between MitraClip implantation and ablation was 1019.0 ± 783.0 days. After transseptal puncture, ablation catheter was successfully steered through the mitral valve with the use of fluoroscopy. A complete high-density map of the substrate in sinus rhythm could be obtained in all patients using multipolar mapping catheters. In 1 patient, mapping was carried out using a mini-basket catheter. Procedural endpoints, noninducibility of all VTs, and abolition of all late potentials were achieved in all patients. Procedure time was 255.0 ± 52.5 minute, fluoroscopy time was 23.0 ± 7.3, and the radiation dose was 61.0 ± 37.5 Gycm2. No mitral insufficiency or worsening of regurgitation was documented after the procedure. Conclusions: This is the first report demonstrating the feasibility and safety of VT ablation in patients with a MitraClip device using the anterograde transmitral catheter route. Journal compilation © 2017 Wiley Periodicals, Inc.
Original languageEnglish
Pages (from-to)523-530
Number of pages8
JournalJournal of Cardiovascular Electrophysiology
Volume28
Issue number5
DOIs
Publication statusPublished - 2017

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Catheter Ablation
Ventricular Tachycardia
Equipment and Supplies
Catheters
Fluoroscopy
Mitral Valve Insufficiency
Mitral Valve
Safety
Atrial Appendage
Atrial Heart Septal Defects
Punctures
Stroke Volume
Heart Ventricles
Radiation

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Catheter Ablation of Ventricular Tachycardia in Patients With MitraClip Device: Preliminary Findings. / Haegeli, LM; D'Angelo, G; Trevisi, N; Stella, Stefano; Breitenstein, A; Duru, F; Brunckhorst, C; Della Bella, P.

In: Journal of Cardiovascular Electrophysiology, Vol. 28, No. 5, 2017, p. 523-530.

Research output: Contribution to journalArticle

Haegeli, LM, D'Angelo, G, Trevisi, N, Stella, S, Breitenstein, A, Duru, F, Brunckhorst, C & Della Bella, P 2017, 'Catheter Ablation of Ventricular Tachycardia in Patients With MitraClip Device: Preliminary Findings', Journal of Cardiovascular Electrophysiology, vol. 28, no. 5, pp. 523-530. https://doi.org/10.1111/jce.13180
Haegeli, LM ; D'Angelo, G ; Trevisi, N ; Stella, Stefano ; Breitenstein, A ; Duru, F ; Brunckhorst, C ; Della Bella, P. / Catheter Ablation of Ventricular Tachycardia in Patients With MitraClip Device: Preliminary Findings. In: Journal of Cardiovascular Electrophysiology. 2017 ; Vol. 28, No. 5. pp. 523-530.
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AU - Breitenstein, A

AU - Duru, F

AU - Brunckhorst, C

AU - Della Bella, P

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N2 - VT Ablation in MitraClip Patients: Introduction: Patients with mitral regurgitation are increasingly treated by percutaneous implantation of a MitraClip device (Abbott Park, IL, USA). We investigate the feasibility and safety of the transmitral catheter route for catheter ablation of ventricular tachycardia (VT) in these patients. Methods: The mitral valve with the MitraClip in situ was crossed under transesophageal 3-dimensional echocardiographic and fluoroscopic guidance using a steerable sheath for ablation of the left ventricle. Results: Five patients (all males, median age 74.0 ± 16.0 years) who had previously a MitraClip implanted were referred for catheter ablation of VT. The left ventricular ejection fraction was 29.0% ± 24.0%. One patient had both an atrial septal defect and a left atrial appendage occluder device in addition to a MitraClip. The duration between MitraClip implantation and ablation was 1019.0 ± 783.0 days. After transseptal puncture, ablation catheter was successfully steered through the mitral valve with the use of fluoroscopy. A complete high-density map of the substrate in sinus rhythm could be obtained in all patients using multipolar mapping catheters. In 1 patient, mapping was carried out using a mini-basket catheter. Procedural endpoints, noninducibility of all VTs, and abolition of all late potentials were achieved in all patients. Procedure time was 255.0 ± 52.5 minute, fluoroscopy time was 23.0 ± 7.3, and the radiation dose was 61.0 ± 37.5 Gycm2. No mitral insufficiency or worsening of regurgitation was documented after the procedure. Conclusions: This is the first report demonstrating the feasibility and safety of VT ablation in patients with a MitraClip device using the anterograde transmitral catheter route. Journal compilation © 2017 Wiley Periodicals, Inc.

AB - VT Ablation in MitraClip Patients: Introduction: Patients with mitral regurgitation are increasingly treated by percutaneous implantation of a MitraClip device (Abbott Park, IL, USA). We investigate the feasibility and safety of the transmitral catheter route for catheter ablation of ventricular tachycardia (VT) in these patients. Methods: The mitral valve with the MitraClip in situ was crossed under transesophageal 3-dimensional echocardiographic and fluoroscopic guidance using a steerable sheath for ablation of the left ventricle. Results: Five patients (all males, median age 74.0 ± 16.0 years) who had previously a MitraClip implanted were referred for catheter ablation of VT. The left ventricular ejection fraction was 29.0% ± 24.0%. One patient had both an atrial septal defect and a left atrial appendage occluder device in addition to a MitraClip. The duration between MitraClip implantation and ablation was 1019.0 ± 783.0 days. After transseptal puncture, ablation catheter was successfully steered through the mitral valve with the use of fluoroscopy. A complete high-density map of the substrate in sinus rhythm could be obtained in all patients using multipolar mapping catheters. In 1 patient, mapping was carried out using a mini-basket catheter. Procedural endpoints, noninducibility of all VTs, and abolition of all late potentials were achieved in all patients. Procedure time was 255.0 ± 52.5 minute, fluoroscopy time was 23.0 ± 7.3, and the radiation dose was 61.0 ± 37.5 Gycm2. No mitral insufficiency or worsening of regurgitation was documented after the procedure. Conclusions: This is the first report demonstrating the feasibility and safety of VT ablation in patients with a MitraClip device using the anterograde transmitral catheter route. Journal compilation © 2017 Wiley Periodicals, Inc.

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