Abstract
Background—Catheter ablation of ventricular tachycardia (VT) is associated with the risk of cerebral embolism. The origin of periprocedural brain embolism in the setting of VT ablation is often unknown and strategies to avoid it are sparse. The aim of this study was to assess the safety and feasibility of an endovascular 2-filter-based cerebral protection system (CPS) in left ventricular VT ablation procedures in patients with ischemic heart disease. Furthermore, histopathological correlates of periprocedural embolization were investigated. Methods and Results—In this pilot study, 11 patients with ischemic heart disease and sustained VT underwent left ventricular catheter ablation under CPS surveillance. The placement of the CPS was conducted before the ablation procedure via the right radial artery. The VT ablation procedure was performed via a combined transaortic and transseptal approach. All VTs were successfully ablated. Placement and retrieval of the CPS was successful and safe in all cases. No periprocedural complications related to the CPS were observed and no periprocedural transient ischemic attack or stroke occurred. Debris captured by the CPS was detected in all patients. Histology revealed that acute thrombus was the most common type of debris (91%), followed by arterial wall tissue (73%) and foreign material (55%). Less frequently found were myocardium (27%), calcification (9%), necrotic core (9%), and valve tissue (9%). Conclusions—Cerebral protection during VT ablation seems to be safe and feasible. Ablation procedures of VT are associated with embolization of embolic debris, which was found in every patient.
| Original language | English |
|---|---|
| Article number | e009005 |
| Journal | Journal of the American Heart Association |
| Volume | 7 |
| Issue number | 13 |
| DOIs | |
| Publication status | Published - 01.07.2018 |
Funding
This work was supported by Claret Medical, Inc, Santa Rosa, CA. Heeger received travel grants by Medtronic, Biotronik, Biosense Webster, and St. Jude Medical. Kuck received travel grants and research grants from Claret Medical, Inc; Biosense Webster, Stereotaxis, Prorhythm, Medtronic, Edwards, Cry-ocath, and is a consultant to St. Jude Medical, Biosense Webster, Prorhythm, and Stereotaxis. He received speaker’s honoraria from Medtronic. He received lecture honoraria from Claret Medical, Inc and Edwards. Rillig received travel grants from Biosense, Hansen Medical, and St. Jude Medical and lecture fees from St. Jude Medical and Boehringer Ingelheim and took part at the Boston scientific EP fellowship. Metzner received speaker’s honoraria and travel grants from Med-tronic, Biosense Webster and Cardiofocus and took part at the Boston scientific EP fellowship. Tilz reports grants, personal fees and non-financial support from Biosense Webster, personal fees, and nonfinancial support from Hansen Medical, personal fees, and nonfinancial support from St. Jude Medical, nonfinancial support from Abbott, outside the submitted work. Schmidt has received lecture honoraria from Claret Medical, Inc and Medtronic, Inc; Virmani has been in the advisory board of Medtronic, Inc and received research grants from Medtronic and Edwards. The remaining authors have no disclosures to report.
