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

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 (allmales, median age 74.0 +/- 16.0 years) who had previously aMitraClip 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 Gycm(2). 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.