Mortality in Recipients of Durable Left Ventricular Assist Devices Undergoing Ventricular Tachycardia Ablation

Lynch, Patrick T.; Maloof, Alexandra; Badjatiya, Anish; Safavi-Naeini, Payam; Segar, Matthew W.; Kim, Jitae A.; Marashly, Qussay; Molina-Razavi, Joanna E.; Simpson, Leo; Oberton, Selby B.; Xie, Lola X.; Civitello, Andrew; Mathuria, Nilesh; Cheng, Jie; Rasekh, Abdi; Saeed, Mohammad; Razavi, Mehdi; Nair, Ajith; Chelu, Mihail G.

doi:10.1016/j.jacep.2024.04.037

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2024

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Ablation as Salvation…Via Transplantation?

Moss

2024

JACC: Clinical Electrophysiology

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Ablation as Salvation…Via Transplantation?

Moss

2024

JACC: Clinical Electrophysiology

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Characterization of ventricular tachycardia ablation in end-stage heart failure patients with left ventricular assist device (CHANNELED registry)

van den Bruck,

Hohendanner,

Heil

et al. 2024

Preprint

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Background: Patients with left-ventricular-assist-devices (LVAD) are at high risk for ventricular tachycardia (VT), and data on VT ablation in LVAD patients is scarce. This multicenter registry assessed the mechanism of VT, procedural parameters, and outcome of VT ablation in LVAD patients (NCT06063811). Methods: Data of LVAD patients referred for VT ablation at 9 tertiary care centers were collected retrospectively. Parameters included VT mechanisms, procedural data, VT recurrence, and mortality. Results: Overall, 69 patients (90% male, mean age 60.7±8.4 years) undergoing 72 catheter ablation procedures were included. Most procedures were conducted after intensification of antiarrhythmic drug (AAD) treatment (18/72; 25%) or after prior combination of 2 AADs (31/72; 43%). Endocardial low voltage areas were detected in all patients. 96 different VTs were targeted. The predominant mechanism was scar-related re-entry (76/96 VTs; 79%) and 19/96 VTs (20%) were related to the LVAD cannula. Non-inducibility of any VT was achieved in 28/72 procedures (39%). No LVAD related complication was observed. The extent of endocardial scar was associated with VT recurrence. Over a median follow-up of 283 days (IQR 70-587 days), 3/69 were lost to follow-up, 10/69 (14%) patients were transplanted, 26/69 (38%) died, and 16/69 (23%) patients were free from VT. Conclusion: Although often a last resort, VT ablation in LVAD patients is feasible and safe when performed in experienced centers. These patients suffer from a high scar burden, and cardiomyopathy-associated rather than cannula-related scar seems to be the dominant substrate. VT recurrence after ablation is high, despite extensive treatment, and the overall prognosis of these patients is limited.

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Mortality in Recipients of Durable Left Ventricular Assist Devices Undergoing Ventricular Tachycardia Ablation

Cited by 2 publications

References 44 publications

Ablation as Salvation…Via Transplantation?

Ablation as Salvation…Via Transplantation?

Characterization of ventricular tachycardia ablation in end-stage heart failure patients with left ventricular assist device (CHANNELED registry)

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