Open-chest epicardial mapping and ablation during LVAD implantation resulted in 0 recurrent ventricular tachycardia episodes without anti-arrhythmic drugs over a 15-month follow-up.
Case Report (n=1)
Does open-chest epicardial ablation during LVAD implantation prevent recurrent ventricular tachycardia in a patient with advanced heart failure?
Intraoperative epicardial mapping and ablation during LVAD implantation may be a safe and effective strategy to prevent recurrent ventricular arrhythmias in patients with preexisting cardiomyopathy substrate.
Background: Ventricular arrhythmias (VAs) are common after a left ventricular assist device (LVAD) implantation. Further, the majority of post-LVAD ventricular tachycardias (VTs) are secondary to a preexisting cardiomyopathy substrate. Intraoperative ablation of patients with recurrent preoperative VTs may reduce post-LVAD VTs. Case summary: A 59-year-old female with advanced heart failure due to non-ischaemic cardiomyopathy (LV ejection fraction = 24%) and recurrent VTs was referred for an LVAD implantation as a bridge to a heart transplant (INTERMACS Profile-5A). The previous endocardial ablation failed due to an epicardial arrhythmogenic substrate. Therefore, open-chest epicardial mapping during the LVAD implantation was indicated and three target areas of the arrhythmogenic substrate were found, which were ablated by radiofrequency applications. To minimize the cardiopulmonary bypass time, cardiopulmonary bypass was initiated after ablation, and then, an LVAD was implanted. An additional 68 min was required for mapping and ablation. All procedures were performed without any complications, and the post-operative course was uneventful. Thereafter, no VT episodes were observed without any anti-arrhythmic drugs during a 15-month follow-up with LVAD support. Discussion: Intraoperative epicardial mapping and ablation during an LVAD implantation can play an important role in the management of LVAD recipients with recurrent VAs.
Fukuzawa et al. (Fri,) conducted a case report in Advanced heart failure with recurrent ventricular tachycardias (n=1). Open-chest epicardial mapping and radiofrequency ablation during LVAD implantation was evaluated on Recurrence of ventricular tachycardia episodes. Open-chest epicardial mapping and ablation during LVAD implantation resulted in 0 recurrent ventricular tachycardia episodes without anti-arrhythmic drugs over a 15-month follow-up.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: