Catheter Ablation of Ventricular Tachycardia in Patients With a Ventricular Assist Device

Massive myocardial edema and inflow cannula obstruction due to epicardial surgical ventricular tachycardia cryoablation at time of left ventricular assist device implantation

“…A recent meta-analysis has been published that looks at the use and efficacy of VT ablation after LVAD implantation. 3 This study included 18 studies and a total of 110 patients and showed a reasonable procedural success—with noninducible clinical VT achieved in 77.9% of patients and a low complication rate (9.4%). These studies have showed that there was a significant reduction in ICD therapy (57.1% vs 23.8%), albeit with a very high rate of VT recurrence (43.6%).…”

Ablation therapy for ventricular arrhythmias in patients with LVAD: Multiple faces of an electrophysiological challenge

“…In the case series by Anderson et al the activation mapping and the entrainment mapping were used in 60% of cases, the substrate mapping in 20% of cases (<1.5 mV) and in the remaining 20% a combination of both was used. These proportion are different from non LVAD patients in whom the VAs ablation is predominantly guided by substrate mapping 50 …”

“…Concerning the access to left ventricle (LV), the trans‐septal puncture should be considered the first choice since the retrograde aortic access is usually limited by low peripheral arterial flow. Moreover the reduced opening of the aortic cusps represents a source of thromboembolism even in patients under anticoagulation therapy, making trans‐esophageal echocardiography (TOE) very useful previously to the retrograde access 31,50 . This step can also be facilitated by intracardiac echocardiography (ICE) through visualization of LV outflow tract and the aortic valve.…”

Ventricular Tachycardia Ablation in Patients with Left Ventricular Assist Devices

“…In a meta-analysis of 18 studies on the catheter ablation of VA post-LVAD implantation, 90.3% of the VAs were found to be of scar-related reentry origin, while 19.3% were related to the LVAD cannula. 6 Following successful catheter ablation, the VT storm terminated in 90% of patients and there was a significant reduction in ICD therapy applications as compared with prior to surgery (23.8% versus 57.1%). Activation/entrainment mapping was performed in 61.2% of the patients.…”

“…However, it is well-recognized that ventricular arrhythmia (VA) burden may actually rise following the implantation of an LVAD, 2 which is associated with a decrease in patient survival. 3 Catheter ablation for recurrent, drug-refractory ventricular tachycardia (VT) in patients with structural heart disease is well-established, [4][5][6] resulting in fewer appropriate implantable cardioverter-defibrillator (ICD) shocks and repeat hospitalizations. In this report, we discuss the case of a patient with drug-refractory VA following LVAD placement that was successfully mapped and terminated with catheter ablation.…”