Abstract 13207: Successful Catheter Ablation of Symptomatic Ventricular Arrhythmia After Left Ventricular Assist Device Implantation
Introduction: Ventricular tachycardia (VT) is a common finding following implantation of a continuous-flow left ventricular assist device (LVAD). We report our experience, technical feasibility and efficacy of endocardial VT-ablation to treat symptomatic patients with LVAD.
Hypothesis: Interventional ablation of VT after LVAD implantation can be performed effectively and safely.
Methods: A retrospective analysis of all patients supported with a LVAD who were referred for catheter ablation to treat recurrent symptomatic VT was performed.
Results: Between January 2012 and August 2014, 159 patients underwent implantation of a LVAD. In eight patients (all of whom had an ICD before LVAD implantation) an ablation was indicated due to recurrent episodes of VT, leading to ICD shock or recurrent hemodynamic instability. A total of 11 ablation procedures were performed. The first ablation was performed after an average of 142 ± 130 days after LVAD implantation. Between the implantation of the LVAD and the first ablation procedure 24 ± 18 appropriate shocks per patient were delivered. For catheter ablation the CARTO 3 mapping system was utilized. Nine clinical VT episodes were able to be induced in four patients. Seven of these VT epsiodes (77.8%) were successfully ablated after activation mapping in these patients. In two patients a monomorphic VT origin was located in the epicardium and could not be ablated successfully, but only in one patient was it inducible at the end of the procedure (12.5%). In six patients voltage mapping was conducted. The low voltage area in four patients extended to the implantation area of the inflow cannula, and of these, all were rendered non-inducible after ablation. All patients remained hemodynamically stable during the procedure. Although the majority had a reduction in VA frequency, in two patients clinical VT recurred, making a second ablation necessary. There were no complications associated with the ablation procedures. The patients were free from ICD shock for an interval of 209 ± 193 days.
Conclusions: VT ablation is a feasible, safe and effective treatment option in patients with recurrent triggering of VT episodes leading to ICD shock after implantation of a LVAD.
Author Disclosures: J. Garbade: None. J. Fischer: None. S. Lehmann: None. A. Meyer: None. A. Arya: None. G. Hindricks: None. F. Mohr: None.
- © 2016 by American Heart Association, Inc.