Abstract 4143443: Characteristics of patients with left ventricular aneurysms undergoing ventricular tachycardia ablation

Background: Left ventricular aneurysms (LVAs) are associated with a higher risk of occurrence of ventricular tachycardia (VT). Although there have been smaller studies and case-reports published on the role of catheter ablation of VT in patients with LVAs, larger case-series with relatively longer follow up after VT ablation are limited. Purpose: We sought to assess procedural characteristics and clinical outcomes after VT ablation in patients with LVAs. Methods: We performed a retrospective review on consecutive sets of patients with LVAs who had undergone VT ablation between 01/2015 and 10/2023 at our center. The diagnosis and segmental location of LVAs was confirmed by two independent reviewers (AM and KV) upon review of images from either a transthoracic echocardiogram or cardiac magnetic resonance imaging (cMRI). Procedural reports of VT ablation were reviewed for the characteristics of electroanatomical mapping, number and morphological features of VTs induced and ablation parameters. Data on outcomes after VT ablation was collected by using a combination of clinical follow up and data from remote monitoring and in-person device interrogations. Results: A total of 33 patients with LVAs underwent VT ablation at our center between 2015 and 2023. The average age of patients in our study cohort was 65 +/- 15 years and 88% of them were males. The average left ventricular ejection fraction was 34 +/- 12% and the etiology of the LVAs was ischemic in 58% and non-ischemic in 42% of patients. In the non-ischemic subgroup, the most common etiology was hypertrophic cardiomyopathy (27%) followed by other causes such as mycotic aneurysm (3%), congenital aneurysm (3%), aneurysm secondary to dilated cardiomyopathy (3%) and causes that were unclear (6%). The most common segment involved in the LVAs was apical (85%) followed by basal (in 15%) of patients. The median number of distinct VTs induced and ablated during VT ablation procedure was 2 (IQR: 1-3). The average cycle length of the VTs induced was 353 + 85 ms and the predominant morphology was right bundloid (in 77% of VTs induced). Follow up Data: Upon a median follow up of 245 (IQR of 86-898) days, the overall success rate of VT ablation was 68%. Conclusions: Occurrence of VT is quite common in patients with LVAs in the setting of ischemic and non-ischemic etiologies. Our case-series describes the safety and feasibility of catheter ablation for VT in patients with LVAs.