title: Catheter Ablation of Ventricular Tachycardia in Patients With MitraClip Device: Preliminary Findings.
abstract: BACKGROUND
  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.
authors.affiliation: Arrhythmia and Electrophysiology, University Heart Center, Zurich, Switzerland.
authors.forename: Laurent M
authors.initials: LM
authors.lastname: Haegeli
authors.affiliation: Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele University Hospital, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Angelo
authors.affiliation: Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele University Hospital, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Trevisi
authors.affiliation: Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele University Hospital, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Stella
authors.affiliation: Arrhythmia and Electrophysiology, University Heart Center, Zurich, Switzerland.
authors.forename: Alexander
authors.initials: A
authors.lastname: Breitenstein
authors.affiliation: Arrhythmia and Electrophysiology, University Heart Center, Zurich, Switzerland.
authors.forename: Firat
authors.initials: F
authors.lastname: Duru
authors.affiliation: Arrhythmia and Electrophysiology, University Heart Center, Zurich, Switzerland.
authors.forename: Corinna
authors.initials: C
authors.lastname: Brunckhorst
authors.affiliation: Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele University Hospital, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Della Bella
mesh_terms: D000200:Action Potentials; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000009:adverse effects; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D022062:Electrophysiologic Techniques, Cardiac; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006339:Heart Rate; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D015641:Radiography, Interventional / Q000379:methods; D012042:Registries; D013557:Switzerland; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: MitraClip device; catheter ablation; electroanatomic mapping; mitral regurgitation; ventricular tachycardia