title: Ventricular Tachycardia Ablation in the Presence of Left Ventricular Thrombus: Safety and Efficacy.
abstract: BACKGROUND
  The safety of ventricular tachycardia (VT) ablation in patients with laminated left ventricular (LV) thrombus has not been examined.
  
  
  METHODS
  Patients with laminated LV thrombus on transthoracic echocardiogram who underwent scar-mediated VT ablation at two centers from 2010 to 2013 were retrospectively analyzed. All patients had failed medical therapy. Acute procedural outcomes, complications, and clinical outcomes at 1 year were assessed.
  
  
  RESULTS
  Eight patients (four ischemic, four nonischemic cardiomyopathy) underwent VT ablation in the presence of laminated intracavitary thrombus. Six out of eight (75%) had electrical storm (ES). The mapping and ablation approach was LV endocardial-only in three patients, epicardial-only in two, combined epicardial-RV endocardial in two, and combined epicardial-LV endocardial in one. Major complication (ischemic stroke) occurred in one patient 9 days post-procedure. There was no procedural mortality. Complete acute procedural success (noninducibility of any VT after ablation) was achieved in five (63%), and partial success (ablation of only clinical VT) in an additional three (37%). At 1 year, freedom from VT and survival were achieved in six (75%) and seven (88%) patients, respectively.
  
  
  CONCLUSIONS
  Initial data suggest that ablation of VT in the presence of intracavitary thrombus is feasible, is associated with a similar success rate to historical studies in patients without thrombus, and has an acceptable risk of complications given the high-risk nature of patients with ES. Further data are needed; however, the presence of a laminated thrombus should not necessarily preclude ablation in patients who have failed medical therapy for VT in whom ablation is otherwise indicated.
authors.affiliation: Division of Cardiac Electrophysiology, Krishna Institute of Medical Sciences, Hyderabad, India.
authors.forename: Hygriv B
authors.initials: HB
authors.lastname: Rao
authors.affiliation: UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Ricky
authors.initials: R
authors.lastname: Yu
authors.affiliation: Division of Cardiac Electrophysiology, Krishna Institute of Medical Sciences, Hyderabad, India.
authors.forename: Nishad
authors.initials: N
authors.lastname: Chitnis
authors.affiliation: UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Duc
authors.initials: D
authors.lastname: DO
authors.affiliation: UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Noel G
authors.initials: NG
authors.lastname: Boyle
authors.affiliation: UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Kalyanam
authors.initials: K
authors.lastname: Shivkumar
authors.affiliation: UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Bradfield
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D013927:Thrombosis / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality / Q000601:surgery
keywords: ablation; complication; efficacy; intracavitary thrombus; ventricular tachycardia