Left Atrial Appendage Thrombus Prior to Ventricular Tachycardia Ablation: Is Combined Treatment a Viable Option?

Catheter-based ventricular tachycardia (VT) ablation is widely recognized as a first-line treatment for patients with VT and structural heart disease. However, one major contraindication for this procedure is the presence of intraventricular thrombus, which is commonly associated with ventricular aneurysms. Furthermore, in patients with atrial fibrillation undergoing VT ablation, it is essential to rule out atrial thrombus due to the increased risk of embolic events, which may arise from catheter interactions or thrombus displacement during shocks delivered throughout the procedure. When an atrial thrombus is detected, the procedure is typically canceled, leading to a delay in VT ablation and an increased risk of recurrent VT episodes. In such scenarios, a combined strategy involving percutaneous left atrial appendage closure followed by VT ablation may present a feasible alternative, potentially allowing for the safe and effective treatment of both conditions.