In all elective patients with long-term anticoagulation therapy, the procedure was performed after a temporary interruption of warfarin therapy, which was bridged by low-molecular-weight heparin. During left heart procedures, intravenous heparin was administered to maintain the activated clotting time ≈300 seconds. After ablation, patients received antiplatelet therapy for minimum of 6 weeks or anticoagulation therapy in cases of extensive ablation in the left ventricle © 2014 American Heart Association, Inc. Original ArticleBackground-Catheter ablation has become an established treatment modality for a broad spectrum of ventricular tachycardias (VTs). We analyzed incidence and predictors of major complications of VT ablation procedures in a highvolume expert center. Methods and Results-We evaluated 548 consecutive patients who underwent 722 ablation procedures, 473 (65.5%) for structural heart disease VT in the period 2006 to 2012. There were 45 (6.2%) major complications observed in 44 patients. Access site vascular complications were the most frequent (3.6%). Three patients (0.4%) had cardiac tamponade/ hemopericardium, and 5 patients (0.7%) had a thromboembolic event. No procedural deaths occurred. Procedures for structural heart disease VT versus idiopathic VT had a significantly higher complication rate (8.0% versus 2.8%; P=0.006). Similarly, patients with electrical storm (10.1% versus 5.3%; P=0.04) and nonelective procedures (8.4% versus 3.5%; P=0.007) were at higher risk of complications. On multivariate analysis, age >70 years (P=0.01), serum creatinine >115 μmol/L (P=0.0003), and individual operator (P=0.0001) were the only independent predictors of complications.Overall 30-day mortality in the structural heart disease VT group reached 5.0% (patients) and 3.6% (procedures). Death was associated with early recurrence of VT/ventricular fibrillation (P=0.003) and ablation for electrical storm (P=0.02). Conclusions-Complication

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Catheter ablation of VT as the first-line treatment in patients with CAD and relatively preserved LVEF is a viable strategy. It may prevent implantation of the ICD in a considerable proportion of patients. Abolition of all inducible VTs confers low VT recurrence rate over a long-term follow-up.

The development of left ventricular thrombus (LVT) is a well-known and serious complication of acute myocardial infarction (AMI) due to the risk of systemic arterial embolism (SE), which is variable in its clinical picture and has potentially serious consequences depending on the extent of target organ damage. SE results in an increase in mortality and morbidity in these patients. LVT is one of the main causes of the development of ischaemic cardio-embolic cardiovascular events (CVE) after MI and the determination of the source of cardiac embolus is crucial for the initiation of adequate anticoagulant therapy in secondary prevention. Echocardiography holds an irreplaceable place in the diagnosis of LVT, contrast enhancement provides higher sensitivity. The gold standard for LVT diagnosis is cardiac magnetic resonance imaging, but it is not suitable as a basic screening test. In patients with already diagnosed LVT, it is necessary to adjust antithrombotic therapy by starting warfarin anticoagulation for at least 6 months with the need for echocardiographic follow-up to detect thrombotic residues. The effect of prophylactic administration of warfarin in high-risk patients after anterior AMI does not outweigh the risk of severe bleeding complications and does not result in a decrease in mortality and morbidity. At the present time, there is not enough evidence to use direct oral anticoagulants in this indication.