Clinical Observations and Outcome of Ventricular Tachycardia Ablation in Patients with Left Ventricular Assist Devices

Herweg, Bengt; Ilercil, Arzu; Kristof-Kuteyeva, Olga; Rinde‐Hoffman, Debbie; Caldeira, Christiano; Mangar, Devanand; Karlnosky, Rachel; Barold, S. Serge

doi:10.1111/j.1540-8159.2012.03509.x

Cited by 30 publications

(25 citation statements)

References 12 publications

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“…Similarly, there was no interference of the HeartMate II pump on the magnetic field with the ability to accurately track the MediGuide catheter tip (Figure 3), nor with the quality of electrograms observed on the ablation catheter. This finding is consistent with previous reports that have suggested no significant electromagnetic interference between the HeartMate II device and radiofrequency delivery; electroanatomic mapping with the CARTO system, which generates a magnetic field of 2.5–65 µT at frequencies of 2, 2.2, and 3 kHz (Biosense Webster; Johnson & Johnson, New Brunswick, NJ), or EnSite NAVx system (frequency 5.7 kHz; St. Jude Medical) 7, 8, 9, 10…”

Section: Discussionsupporting

confidence: 91%

MediGuide-assisted atrial flutter ablation in a patient with a HeartMate II left ventricular assist device

Thanh

Andrade

Dyrda

et al. 2015

HeartRhythm Case Reports

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Section: Discussionsupporting

confidence: 91%

MediGuide-assisted atrial flutter ablation in a patient with a HeartMate II left ventricular assist device

Thanh

Andrade

Dyrda

et al. 2015

HeartRhythm Case Reports

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“…Although some studies speculated that VT in LVAD patients could be linked to the cannula, 3,14 others have reported findings similar to ours. 10,11 Cantillon et al 10 found that 75% of VTs originated from the intrinsic scar versus 14% from the cannula area. They also found some VTs caused by microreentrant mechanisms (7%) and bundle branch reentry (3.5%).…”

Section: Discussionmentioning

confidence: 99%

“…8 Catheter ablation offers an opportunity to reduce or eliminate these events and has been shown to be feasible in single center studies. [9][10][11] However, the electrophysiological characteristics and outcomes associated with catheter ablation for VAs in patients with Heart Mate II (HM2) device (Thoratec) have not yet been evaluated in a multicenter series.…”

mentioning

confidence: 99%

Characteristics of Ventricular Tachycardia Ablation in Patients With Continuous Flow Left Ventricular Assist Devices

Sacher

Reichlin

Zado

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background-Left ventricular assist devices (LVADs) are increasingly used as a bridge to cardiac transplantation or as destination therapy. Patients with LVADs are at high risk for ventricular arrhythmias. This study describes ventricular arrhythmia characteristics and ablation in patients implanted with a Heart Mate II device. Methods and Results-All patients with a Heart Mate II device who underwent ventricular arrhythmia catheter ablation at 9 tertiary centers were included. Thirty-four patients (30 male, age 58±10 years) underwent 39 ablation procedures. The underlying cardiomyopathy pathogenesis was ischemic in 21 and nonischemic in 13 patients with a mean left ventricular ejection fraction of 17%±5% before LVAD implantation. One hundred and ten ventricular tachycardias (VTs; cycle lengths, 230-740 ms, arrhythmic storm n=28) and 2 ventricular fibrillation triggers were targeted (25 transseptal, 14 retrograde aortic approaches). Nine patients required VT ablation <1 month after LVAD implantation because of intractable VT. Only 10/110 (9%) of the targeted VTs were related to the Heart Mate II cannula. During follow-up, 7 patients were transplanted and 10 died. Of the remaining 17 patients, 13 were arrhythmia-free at 25±15 months. In 1 patient with VT recurrence, change of turbine speed from 9400 to 9000 rpm extinguished VT. Conclusions-Catheter ablation of VT among LVAD recipients is feasible and reasonably safe even soon after LVAD implantation. Intrinsic myocardial scar, rather than the apical cannula, seems to be the dominant substrate.

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“…Until now publications usually dealt with VTs originating near the cannula, but there are scarce data about VTs arising from the intrinsic scar [1][2][3][4][5].…”

Section: Sirsmentioning

confidence: 99%

Successful emergency ablation of ventricular tachycardia in the early postoperative period after left ventricular assist device implantation

2015

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Sirs:A case of a 38-year-old male patient is reported. Left ventricular assist device was implanted because of end stage heart failure. In the early postoperative period, electrical storm with rapid ventricular tachycardia (VTs) occurred that was refractory to medical therapy. Emergency VT ablation was performed successfully. VT frequently occurs after LVAD implantation and radiofrequency ablation can be an effective therapeutic option.We report a case of a 38-year-old male patient, who suffered an extensive anterior ST-segment elevation myocardial infarction in 2002 treated with thrombolysis. LAD PCI (2005), amiodarone-induced hyperthyreosis (2007) and primary prophylactic ICD implantation (2008) are the most relevant findings in his past medical history. Since then he required several hospitalizations for worsening heart failure symptoms. In May 2013, he was admitted due to rapid VT causing hemodynamic instability requiring two appropriate ICD shocks. Heart transplantation was considered as an option but it was contraindicated because of high pulmonary vascular resistance refractory to vasodilator therapy. Left ventricular assist device (LVAD, HeartMate II) implantation was performed as ''destination therapy''. In the early postoperative period (5 days after implantation) electrical storm occurred requiring multiple ICD shocks. Shock therapy of ICD was deactivated and multiple external electric cardioversions were needed despite the intravenous administration of high dose antiarrhythmic drugs (amiodarone, procainamide and beta blocker). Due to drug refractory electrical storm radiofrequency ablation of the incessant VT was decided in the early postoperative period. Procedure was performed under uninterrupted anticoagulation, respecting the high thromboembolic risk of the assist device. We decided to use transaortic retrograde approach only. During the electrophysiological study sustained monomorphic VT was inducible (cycle length: 330 ms, superior axis, right bundle branch block morphology). During ongoing arrhythmia, rapid electroanatomic mapping (CARTO3, Biosense Webster) was performed which found that the site of earliest activation is at the inferoseptal region of the left ventricle, in the intrinsic myocardial scar near to the junction of the inflow cannula. The exit point was also identified at the same site with entrainment mapping. Then 5 radiofrequency ablations were applied (total ablation time 790 s, energy 40 W, temperature 43°C) using 3.5 mm irrigated tip catheter (Thermocool, D curve, Biosense Webster). We would like to highlight that the ablation site was near to the inflow cannula but we kept some distance from the device to avoid damaging of the surgical sutures. The VT stopped immediately and was no longer inducible even with 2 ventricular extrastimuli at 330 ms drive. No complications were observed during or in relation to the ablation procedure (total procedure time: 45 min, fluoroscopy time: 8 min). After the procedure, patient was free of sustained VT episodes during the 12-month follo...

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Clinical Observations and Outcome of Ventricular Tachycardia Ablation in Patients with Left Ventricular Assist Devices

Abstract: Ablation of VT in LVAD patients is feasible and can result in a markedly decreased VT burden with a reduction of ICD shocks. The subsequent discontinuation of intravenous antiarrhythmic medications may facilitate hospital discharge.

Cited by 30 publications

References 12 publications

MediGuide-assisted atrial flutter ablation in a patient with a HeartMate II left ventricular assist device

MediGuide-assisted atrial flutter ablation in a patient with a HeartMate II left ventricular assist device

Characteristics of Ventricular Tachycardia Ablation in Patients With Continuous Flow Left Ventricular Assist Devices

Successful emergency ablation of ventricular tachycardia in the early postoperative period after left ventricular assist device implantation

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