Prevalence and risk factors of cardiac thrombus prior to ventricular tachycardia catheter ablation in structural heart disease. Issue 2 (10th November 2022)

• Record Type: Journal Article
• Authors: Bonnin, Thomas; Roumegou, Pierre; Sridi, Soumaya; Mahida, Saagar; Bustin, Aurélien; Duchateau, Josselin; Tixier, Romain; Derval, Nicolas; Pambrun, Thomas; Chniti, Ghassen; Takagi, Takamitsu; Kamakura, Tsukasa; Krisai, Philipp; Andre, Clementine; Chauvel, Rémi; Hocini, Meleze; Haissaguerre, Michel; Jais, Pierre; Cochet, Hubert; Sacher, Frederic
• Is Part Of: Europace. Volume 25:Issue 2(2023)
• Page Start: 487
• Page End: 495
• Publication Date: 2022-11-10
• Subjects: Thrombus -- Ventricular tachycardia -- Catheter ablation -- Structural heart disease; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euac156
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: Assess prevalence, risk factors, and management of patients with intra-cardiac thrombus referred for scar-related ventricular tachycardia (VT) ablation. Methods and results: Consecutive VT ablation referrals between January 2015 and December 2019 were reviewed ( n = 618). Patients referred for de novo, scar-related VT ablation who underwent pre-procedure cardiac computed tomography (cCT) were included. We included 401 patients [61 ± 14 years; 364 male; left ventricular ejection fraction (LVEF) 40 ± 13%]; 45 patients (11%) had cardiac thrombi on cCT at 49 sites [29 LV; eight left atrial appendage (LAA); eight right ventricle (RV); four right atrial appendage]. Nine patients had pulmonary emboli. Overall predictors of cardiac thrombus included LV aneurysm [odds ratio (OR): 6.6, 95%, confidence interval (CI): 3.1–14.3], LVEF < 40% (OR: 3.3, CI: 1.5–7.3), altered RV ejection fraction (OR: 2.3, CI: 1.1–4.6), and electrical storm (OR: 2.9, CI: 1.4–6.1). Thrombus location-specific analysis identified LV aneurysm (OR: 10.9, CI: 4.3–27.7) and LVEF < 40% (OR: 9.6, CI: 2.6–35.8) as predictors of LV thrombus and arrhythmogenic right ventricular cardiomyopathy (OR: 10.6, CI: 1.2–98.4) as a predictor for RV thrombus. Left atrial appendage thrombi exclusively occurred in patients with atrial fibrillation. Ventricular tachycardia ablation was finally performed in 363 including 7 (16%) patients with thrombus but refractory electrical storm. These seven patients had tailored ablation with no embolic complications. Only one (0.3%) ablation-related embolic event occurred in the entire cohort. Conclusion: Cardiac thrombus can be identified in 11% of patients referred for scar-related VT ablation. These findings underscore the importance of systematic thrombus screening to minimize embolic risk. Graphical Abstract: Graphical Abstract