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Two weeks later, he developed VT storm; initial ablation consideration was deferred after cardiac CT showed M-TEER-associated thrombus on the ventricular surface of the posterior mitral leaflet. Despite amiodarone, VT storm recurred. Multidisciplinary discussion led to emergent rescue VT ablation using a cerebral embolic protection device with mechanical support as needed, with no VT recurrence at 2.5 months.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/rescue-upon-rescue-ventricular-tachycardia-ablation-using-cerebral-protection-device-in-a-patient-with-left-ventricular-thrombus-associated-with-mitral-valve-transcatheter-repair/430379/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/rescue-upon-rescue-ventricular-tachycardia-ablation-using-cerebral-protection-device-in-a-patient-with-left-ventricular-thrombus-associated-with-mitral-valve-transcatheter-repair/430379.png","ImageObject",300,407,{"name":42,"@type":43},"Margaret","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-04","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",11,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why 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\n[https://doi.org/10.1007/s10840-025-02192-8](https://doi.org/10.1007/s10840-025-02192-8)  \nCASE REPORT  \nRescue upon rescue: ventricular tachycardia ablation using cerebral protection device in a patient with left ventricular thrombus associated with mitral valve transcatheter repair  \nElie Kozaily1 · Bishnu P. Dhakal1 · Ian Laxina1 · Rory P. Dowd1 · Chau Vo1 · Jeffrey Winterfield1  \nReceived: 29 October 2025 / Accepted: 14 November 2025 / Published online: 25 November 2025 © The Author(s) 2025  \nAbstract We present the case of an elderly man with advanced heart failure and worsening severe mitral regurgitation who underwent transcatheter mitral valve edge-to-edge repair (M-TEER) who presented with VT storm 2 weeks after M-TEER. VT ablation was considered but not performed since cardiac CT scan revealed M-TEER associated thrombus on the ventricular surface of the posterior mitral leaflet. Despite being on amiodarone, the patient returned few days later with VT storm. After multidisciplinary assessment and patient-centric discussions, the decision was made to proceed with emergent, rescue VT ablation using cerebral embolic protection device (CEP) and mechanical support as needed. VT ablation was safe and successfully performed. Patient had no recurrence of VT during 2.5 month follow up. To our knowledge, this is the first reported case of VT ablation using CEP for LV thrombus in North America.  \nCapsule abstract Emergent, successful VT ablation in advanced HF patient with transcatheter mitral prosthesis associated left ventricular thrombus using cerebral protection device.  \nKeywords Ventricular tachycardia · Heart failure · Ventricular tachycardia ablation  \nWe present the case ofa 78-year-old man with metabolic syndrome associated chronic kidney disease KDIGO stage 3b, ischemic cardiomyopathy with two remote coronary artery bypass graft surgeries (left internal mammary artery to left anterior descending (LAD) artery, and saphenous venous graft (SVG) to LAD and SVG to diagonal coronary artery), advanced stage heart failure with reduced ejection fraction (HFrEF) ACC/AHA stage D, ventricular tachycardia (VT) on chronic amiodarone, atrioventricular block requiring biventricular pacing, and moderate to severe mitral regurgitation. He had lack of improvement in left ventricular (LV) function despite guideline directed medical therapy (GDMT) . He has severe underlying native coronary disease not amenable to percutaneous revascularization with occluded LIMA to LAD.  \nHis first episode of VT happened 6 years ago, leading up to upgrade from pacemaker to biventricular cardiac defibrillator for secondary prevention. He has required chronic  \n􀀍 Jeffrey Winterfield [winterfj@musc.edu](winterfj@musc.edu)  \n1 Hank and Laurel Greer Chair in Cardiac Electrophysiology Chief, Cardiac Rhythm Services, Medical University of South Carolina (MUSC), Charleston, SC, USA  \namiodarone therapy for episodes of VT. One month prior to VT storm presentation, given persistent HF symptoms with maximally tolerated GDMT, the patient underwent transcatheter mitral valve edge-to-edge repair (M-TEER) for severe secondary mitral regurgitation (MR) . During the procedure, the patient developed VT at 120 bpm which was terminated with anti-tachycardia pacing from his device.  \nFour weeks following M-TEER, the patient presented with multiple symptomatic VT episodes despite being on amiodarone. InHeart cardiac CT scan (Bordeaux, France) and echocardiography revealed 1.8 cm thrombus on the ventricular side of the posterior mitral valve prosthesis with mild eccentric MR. LV inferior and inferolateral walls were akinetic with evidence of transmural delayed hyperenhancement on CT scan. Antiarrhythmic drug (AAD) therapy was titrated, with addition of mexiletine. VT ablation was considered but differed given associated risks of embolization with LV thrombus. The patient was deemed not a candidate for advance","cbCaik8FbngRCM7L","https://ap.wps.com/l/cbCaik8FbngRCM7L","pdf",965562,"English","# Case report\n## Patient presentation after M-TEER\n## Thrombus finding and ablation decision\n## Rescue VT ablation with cerebral protection device\n## Follow-up outcome","[{\"question\":\"Why was VT ablation initially not performed after the first VT storm?\",\"answer\":\"VT ablation was deferred because cardiac CT revealed an M-TEER-associated thrombus on the ventricular surface of the posterior mitral leaflet, increasing embolization risk.\"},{\"question\":\"What led to proceeding with emergent rescue VT ablation?\",\"answer\":\"VT storm recurred despite amiodarone, and after multidisciplinary assessment and patient-centered discussions, the team chose emergent rescue ablation using a cerebral embolic protection device and mechanical support as needed.\"},{\"question\":\"What was the outcome after rescue VT ablation?\",\"answer\":\"The procedure was successful and the patient had no recurrence of VT during a 2.5-month follow-up.\"}]","Rescue upon rescue - ventricular tachycardia ablation using cerebral protection device in a patient with left ventricular thrombus associated with mitral valve transcatheter repair | PDF",1790652655]