Catheter Ablation of Ventricular Tachycardia in Patients With a Ventricular Assist Device

• Published in: JACC. Clinical electrophysiology 2019-01, Vol.5 (1), p.39-51
• Main Authors: Anderson, Robert D., Lee, Geoffrey, Virk, Sohaib, Bennett, Richard G., Hayward, Christopher S., Muthiah, Kavitha, Kalman, Jonathan, Kumar, Saurabh
• Format: Article
• Language: English
• Subjects: BIVAD; catheter ablation; LVAD; mechanical support; radiofrequency ablation; RVAD; ventricular assist device; ventricular tachycardia
• ISSN: 2405-500X; 2405-5018
• DOI: 10.1016/j.jacep.2018.08.009

This is a systematic review summarizing the procedural characteristics and outcomes of ventricular assist device (VAD)–related ventricular tachycardia (VT) ablation. Drug-refractory VT refractory commonly develops post-VAD implantation. Procedural and outcome data come from small series or case reports. An electronic search was performed using major databases. Primary outcomes were VT recurrence, mortality, and cardiac transplantation. Secondary endpoints were acute procedural success and procedural complications. Eighteen studies were included, with a total of 110 patients (mean age 59.6 ± 11 years, 89% men; VT storm 34%). Scar-related re-entry was the predominant mechanism of VT (90.3%) and cannula-related VT in 19.3% cases. Electroanatomical mapping interference occurred in 1.8% of cases; there were no reports of catheter entrapment. Noninducibility of clinical VT was achieved in 77.9%; procedural complications occurred in 9.4%. At a mean follow-up of 263.5 ± 267.0 days, VT recurred in 43.6%, 23.4% underwent cardiac transplant, and 48.1% died. There were no procedural-related deaths and no death was directly related to ventricular arrhythmia. In follow-up, there was a significant reduction in implantable cardioverter-defibrillator therapies or shocks (57.1% vs. 23.8%). Ablation allowed VT storm termination in 90% of patients. VAD-related VT is predominantly related to pre-existing intrinsic myocardial scar rather than inflow cannula site insertion. Catheter ablation is a reasonable treatment strategy, albeit with expectedly high rate of recurrence, transplantation, and mortality related to severe underlying disease. [Display omitted]