Severe Aortic Insufficiency after Catheter Ablation of Refractory Ventricular Tachycardias via Retrograde Aortic Approach in a Patient with Left Ventricular Assist Device: a case report

Background Severe aortic insufficiency (AI) after catheter ablation (CA) for ventricular tachycardias (VTs) via a retrograde aortic (RA) approach in patients with left ventricular assist devices (LVADs) has not been reported and is not well recognized. Case Summary A 59-year-old man with dilated cardiomyopathy underwent LVAD implantation as a bridge to transplantation. After 6 months, the drug-resistant VTs increased, and CA was performed via the RA approach since echocardiography showed that the aortic valve was still occasionally open with only trivial AI. After mapping and ablation of the left ventricle (LV), the VTs were acutely suppressed. However, the patient was readmitted to our hospital 8 days later with worsening heart failure. The AI had progressed from trivial to severe and did not improve despite medical therapy; therefore, a surgical aortic valvuloplasty was performed. Since then, the heart failure has resolved for 12 months without AI. Discussion This is the first report of a patient with an LVAD who underwent catheter ablation via an RA approach for VTs and subsequently developed heart failure due to severe AI that required open heart surgery. In patients with LVADs, aortic valves may be prone to catheter-induced deformation or injury, and continuous aspiration of the LV by LVADs can lead to significant AI, requiring open heart surgery. This study demonstrated a real case in which it was important to consider these potential risks when selecting the LV approach as well as during and after the procedures via an RA approach, especially in patients with LVADs.