Abstract 15366: Brain Emboli After Left Ventricular Ablation
Introduction: Ablation for ventricular tachycardia (VT) or premature ventricular complexes (PVCs) is common. Ablation for atrial fibrillation (AF) has been shown to impose risk of subclinical cerebrothromboemboli (CTE), but whether these observations were due to something germane to AF or may occur with VT/PVC ablation remains unknown.
Methods: We enrolled 18 consecutive patients scheduled for VT or PVC ablation over a 9-month period. Patients with implantable devices or contraindications to MRI were excluded. Patients underwent a standard ablation approach using irrigated radiofrequency ablation, including therapeutic heparin administration prior to LV access. Baseline and 1 day post-ablation brain diffusion-weighted MRI’s were performed in each patient.
Results: LV ablation (10 for PVC and 2 for VT) was performed in 12 patients (retrograde and crossing the aortic valve in 11, transseptal only in 1) and RV-only ablation in 6 patients (5 for PVC and 1 for VT). In patients undergoing LV versus RV ablation, there was no difference in age (57.8±10.5 v. 58.3±7.7 years, p=0.92), ejection fraction (55.6±9.4% v. 56.1±10.3%, p=0.93) or number of ablation lesions applied (13.1±6.6 v. 8.3±5.4, p=0.14). Patients undergoing LV ablation had longer procedures (351±51.2 v. 216.5±77.2 minutes, p<0.001). In the LV ablation group, 16 new CTE were identified in 7 patients (58% of all LV patients) (Figure), compared with zero in the RV ablation group (p=0.017). None of the patients were symptomatic. Those with CTE all underwent retrograde procedures (70% of retrograde procedures) and no other differences in procedural characteristics predicted CTE.
Conclusions: Despite a relatively small number of ablation lesions and in the absence of AF, the majority of patients undergoing LV ablation experience CTE, and a retrograde approach to the LV may be a risk factor. Future research is critical to understanding the long-term consequences of these events and to determine preventive strategies.
Author Disclosures: I.R. Whitman: None. R.A. Gladstone: None. N. Badhwar: None. H.H. Hsia: None. B.K. Lee: None. S.A. Josephson: None. K.M. Meisel: None. W.P. Dillon: None. C.P. Hess: None. E.P. Gerstenfeld: None. G.M. Marcus: None.
- © 2016 by American Heart Association, Inc.