Abstract 17366: Intraoperative Ventricular Tachycardia Ablation During Left Ventricular Assist Device Implant in Patients With Medically Refractory Ventricular Tachycardia
Introduction: Patients with advanced heart failure proceeding to LVAD implant require a multidisciplinary approach to their care. These patients often require multimodal therapies for control of their ventricular tachyarrhythmias. Aggressive measures to control arrhythmias should be considered given increased risk of mortality. In this series we report 6 patients with refractory VT who underwent intraoperative endocardial and epicardial VT ablation at the time of LVAD implant.
Results: 6 patients with history of multiple episodes of refractory VT despite anti-arrhythmic therapy underwent concurrent intraoperative endocardial and epicardial VT substrate modification. See table for patient characteristics. Surgical sternotomy was performed and cardiopulmonary bypass was established in all patients. Following LV apical coring, the endocardium and epicardium was inspected and areas of scar were identified. When available, 12 lead ECG of the clinical VT was used to identify potential exit sites, which were targeted for ablation. RF ablation was carried out using a Medtronic Cardioblate BP2 irrigated RF surgical ablation probe. Power delivery was titrated and varied between 20-50 watts. Substrate modification of scar border zones were performed and occasionally linear RF lesions were delivered connecting scar to the mitral annulus or to adjacent scar tissue. Following ablation, the HMII LVAD was successfully implanted. Patients tolerated the procedure well with no immediate complications. 5/6 patients were successfully discharged from the hospital.
Conclusions: We present 6 cases of successful intraoperative VT ablation during LVAD implantation. Our experience illustrates that both endocardial and epicardial RF VT ablation can be safely and effectively achieved during LVAD implantation for long-term VT management. Future studies are needed to determine whether such substrate modification can improve arrhythmia free survival.
Author Disclosures: A. Yoruk: None. D.T. Huang: Research Grant; Significant; Biotronik, Boston Scientific Corp., Medtronic Inc., St. Jude Medical. B.W. Hall: None. S. Rosero: None. S. Sherazi: None. L. Chen: None. V. Kutyifa: Research Grant; Significant; Boston Scientific Corp., Zoll Medical Corp.. H. Massey: None. M.K. Aktas: None.
- © 2016 by American Heart Association, Inc.