https://doi.org/10.1007/s00392-025-02625-4
1Herzzentrum der Universität zu Köln Elektrophysiologie Köln, Deutschland; 2Herz- und Diabeteszentrum NRW Klinik für Elektrophysiologie/ Rhythmologie Bad Oeynhausen, Deutschland
Background
An increasing number of patients present for ablation of ventricular tachycardia (VT) who have previously undergone mitral valve (MV) transcatheter edge-to-edge repair (M-TEER). Ablation of VT requires access to the left ventricle (LV) and an antegrade transseptal access to the LV is a widely used approach. Depending on the underlying substrate, it may be preferable to a retrograde transaortic approach.
While the antegrade transseptal access through the MV is generally safe and well established in native MVs, there is considerable uncertainty among electrophysiologists if – and how safely – a MV can be passed with mapping and ablation catheters after M-TEER has been performed and if this approach affects the repaired valve. Only very few case series are available in the published literature.
Aims
The aim of this multicenter study is to report feasibility of an antegrade transseptal access to the LV for mapping and/or ablation of VT in patients who have undergone previous M-TEER. We further aim to assess if this approach affects residual MV regurgitation.
Methods
We retrospectively analyzed clinical data from two centers and included patients who underwent VT ablation in 2023 and 2024 and who had previously undergone transcatheter MV repair using a clip device. In the reported patients, an antegrade transseptal approach through the clipped MV to the LV was used either for mapping, catheter ablation or both.
Results
Twelve patients [mean age 70 ± 7 years, 83% male, ICM: 7 (58%), DCM: 5 (42%), mean LV-EF 24% ± 12] from two centers were included in the study. Median follow-up after ablation was 365 days (IQR: 160–496 days). For the previous MV repair, a single M-TEER device had been used in five (42%) patients, seven (58%) patients had received two devices. The Mmedian time from M-TEER until VT ablation was 988 days (IQR: 330-1830 days). In all patients, the clipped MV could be passed successfully for mapping and/or catheter ablation. In 11 (92%) patients, echocardiographic data were available after the procedure. A progression of residual regurgitation after the procedure could not be observed in any of the patients included in the study.
Conclusion
In patients who have previously undergone M-TEER, an antegrade transseptal access to the LV was safe and feasible for VT ablation in this cohort.