Abstract 14865: Epicardial Catheter Ablation of Ventricular Tachycardia in Patients at Time of Ventricular Assist Device Implant
PURPOSE: We report the feasibility and outcome of open-chest epicardial ablation of ventricular tachycardia (VT) at the time of surgical ventricular assist device (VAD) implant.
METHODS: Between March of 2009 and October of 2011, 4 patients underwent open chest hybrid epicardial mapping and ablation of recurrent VT during placement of VAD.
RESULTS: All patients (3 males, median age 63, range 52-73) had ischemic cardiomyopathy. Patient #1 had incessant VT after Heartmate II LVAD implant leading to right ventricular assist device (RVAD) implant. While the chest remained exposed, successful substrate based epicardial ablation was performed leading to removal of RVAD. The patient remained VT free and discharged home on LVAD support. Patient #2 had prior endocardial VT ablation with percutaneous circulatory support prior to LVAD placement. Given continued recurrent VT, epicardial ablation at time of LVAD implant was performed without recurrence of VT. Patient #3 with prior endocardial VT ablation had recurrent VT immediately following a Heartmate II placement. Open chest epicardial ablation terminated the clinical VT without recurrence. Patient #4 developed post-cardiotomy shock following coronary bypass surgery requiring placement of an LVAD. Due to refractory VT, the LVAD was removed and patient was placed on ECMO. Epicardial ablation of VT was performed while the chest was open after extraction of LVAD. Due to recurrence, a repeat endocardial/epicardial ablation was successfully done 3 days later with no subsequent VTs. In all patients, VT was either eliminated or significantly reduced with epicardial ablation. No procedure-related complications occurred. Three patients died in the index hospitalization due to other causes (intracranial hemorrhage, sepsis or refractory cardiogenic shock).
CONCLUSION: Open-chest hybrid epicardial ablation for recurrent VT can be considered in select patients at time of surgical VAD implantation although the overall prognosis remains guarded.
- © 2012 by American Heart Association, Inc.