Catheter Ablation of Ventricular Arrhythmias in Patients Supported by Left Ventricular Assist Device

Abstract

Purpose Ventricular arrhythmias (VA) are common following implantation of a left ventricular assist device (LVAD). Morbidity from VA in this population includes right ventricular failure. The optimal treatment strategy for these arrhythmias is unknown. Methods and Materials A retrospective analysis of patients supported by LVAD who were referred for catheter ablation of ventricular tachycardia (VT) between 2005 and the present was performed. Results Six patients were referred for VT ablation an average of 142+166 days following LVAD implantation. Baseline characteristics of the patients are shown below. All patients had a continuous flow LVAD. Four had developed right ventricular failure (defined by the need for right ventricular assist device placement or prolonged pulmonary vasodilators) in the setting of intractable arrhythmias. A retrograde approach was used for 5 patients and an epicardial approach for 1. The pre-procedural clinical VT was inducible in all patients and successfully ablated in 5. The location of these arrhythmias was inferior in 3, lateral in 1, and apical in 2. A total of 8 VTs were ablated in 5 patients. However, ventricular arrhythmias recurred in all but one patient. One patient experienced a bleeding complication following the procedure. Conclusions For patients with a high burden of ventricular arrhythmias following LVAD implantation, catheter ablation of VT is safe and feasible, but clinical arrhythmias frequently recur in this population. Clinical Characteristics of Patients Age (years) 63.5 ± 11.1 Gender (% male) 100 (6) Indication (% BTT) 66.7 (4) Cardiomyopathy Type (%ICM) 66.7 (4) Left Ventricular End Diastolic Dimension (cm) 6.2 ± 1.1 Beta-Blocker (%) 100 (6) Amiodarone (%) 100 (6) Additional Anti-Arrhythmic (%) 66.7 (4) Pre-operative VT Ablation (%) 16.7 (1)