Rescue upon rescue: ventricular tachycardia ablation using cerebral protection device in a patient with left ventricular thrombus associated with mitral valve transcatheter repair

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. Emergent, successful VT ablation in advanced HF patient with transcatheter mitral prosthesis associated left ventricular thrombus using cerebral protection device.