Rao Hygriv B, Yu Ricky, Chitnis Nishad, DO Duc, Boyle Noel G, Shivkumar Kalyanam, Bradfield Jason S
Division of Cardiac Electrophysiology, Krishna Institute of Medical Sciences, Hyderabad, India.
UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
J Cardiovasc Electrophysiol. 2016 Apr;27(4):453-9. doi: 10.1111/jce.12892. Epub 2016 Jan 14.
The safety of ventricular tachycardia (VT) ablation in patients with laminated left ventricular (LV) thrombus has not been examined.
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.
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.
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.
左心室（LV）分层血栓患者进行室性心动过速（VT）消融的安全性尚未得到研究。
对2010年至2013年在两个中心接受瘢痕介导的VT消融且经胸超声心动图显示有LV分层血栓的患者进行回顾性分析。所有患者药物治疗均失败。评估急性手术结果、并发症及1年时的临床结果。
8例患者（4例缺血性心肌病，4例非缺血性心肌病）在存在心腔内分层血栓的情况下接受了VT消融。8例中有6例（75%）发生电风暴（ES）。3例患者的标测和消融方法仅为左心室内膜，2例仅为心外膜，2例为心外膜 - 右心室内膜联合，1例为心外膜 - 左心室内膜联合。1例患者在术后9天发生主要并发症（缺血性卒中）。无手术死亡。5例（63%）实现了完全急性手术成功（消融后任何VT均不能诱发），另外3例（37%）为部分成功（仅消融临床VT）。1年时，分别有6例（75%）和7例（88%）患者无VT发作且存活。
初步数据表明，在心腔内血栓存在的情况下消融VT是可行的，与无血栓患者的历史研究成功率相似，鉴于ES患者的高风险性质，并发症风险可接受。然而，还需要更多数据；不过，对于药物治疗VT失败且其他方面适合消融的患者，分层血栓的存在不一定排除消融治疗。
