Clinical Observations and Outcome of Ventricular Tachycardia Ablation in Patients with Left Ventricular Assist Devices
Article first published online: 4 SEP 2012
©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.
Pacing and Clinical Electrophysiology
Volume 35, Issue 11, pages 1377–1383, November 2012
How to Cite
HERWEG, B., ILERCIL, A., KRISTOF-KUTEYEVA, O., RINDE-HOFFMAN, D., CALDEIRA, C., MANGAR, D., KARLNOSKY, R. and BAROLD, S. S. (2012), Clinical Observations and Outcome of Ventricular Tachycardia Ablation in Patients with Left Ventricular Assist Devices. Pacing and Clinical Electrophysiology, 35: 1377–1383. doi: 10.1111/j.1540-8159.2012.03509.x
- Issue published online: 7 NOV 2012
- Article first published online: 4 SEP 2012
- Received August 1, 2011; revised June 11, 2012; accepted July 9, 2012.
- catheter ablation;
- ventricular tachycardia;
- ventricular assist device;
- heart failure
Background: Ablation of ventricular tachycardia (VT) in patients with left ventricular assist devices (LVAD) is challenging and not well documented. This report describes our experience with endocardial VT ablation in six patients with an LVAD.
Methods: We retrospectively reviewed the clinical records of LVAD patients who underwent an ablation procedure for refractory VT.
Results: A total of eight ablation procedures were performed in six patients who, during the last 2 weeks before the ablation procedure, received a total of 101 appropriate shocks for VT. A closed aortic valve (n = 2) or aortic atheroma (n = 1) required a transseptal catheterization in three of six patients. The apical LVAD cannula served as a VT substrate in two of six patients. VT was eliminated in four patients and markedly reduced in two others. The latter two patients experienced a total of only four implantable cardioverter defibrillator (ICD) shocks during a follow-up of 130 and 493 days. Intravenous antiarrhythmic medications used in five of six patients before ablation were discontinued in all. The ablation procedures permitted hospital discharge in four of six patients. Five patients died during follow-up (228 ± 207 days after the procedure). The cause of death was unrelated to cardiac arrhythmias. One patient is still alive 1,205 days after the procedure.
Conclusion: 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. (PACE 2012; 35:1377–1383)