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September 4, 2012Pacing and Clinical Electrophysiology

Clinical Observations and Outcome of Ventricular Tachycardia Ablation in Patients with Left Ventricular Assist Devices

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Why the study?

Does endocardial VT ablation reduce VT burden and ICD shocks in patients with LVADs and refractory VT?

Population

6 patients with a left ventricular assist device (LVAD) and refractory ventricular tachycardia (VT)

Design

Case_series

Follow-up

228 ± 207 days, 1,205 days

Authors

BHBengt HerwegElectrophysiologyAIArzu IlercilAlbert Einstein College of MedicineOKOlga Kristof-KuteyevaSt. Luke's-Roosevelt Hospital Center

Discussion

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Implication

Endocardial VT ablation may reduce shocks and IV antiarrhythmics in LVAD patients; hypothesis-generating and requires prospective trials before practice change.

Key Points

  • To evaluate the feasibility, procedural characteristics, and clinical outcomes of endocardial catheter ablation for refractory ventricular tachycardia in patients with left ventricular assist devices.
  • Retrospectively reviewed clinical records of patients with left ventricular assist devices (LVADs) who underwent catheter ablation for refractory ventricular tachycardia (N=6; 8 total procedures).
  • Assessed vascular/cardiac access routes (including transseptal catheterization), VT substrate origins, post-ablation ICD shock burden, antiarrhythmic medication weaning, and long-term survival.
  • VT was completely eliminated in 4 of 6 patients and markedly reduced in the remaining 2, with the latter group receiving only 4 ICD shocks during follow-up (130 and 493 days) compared to 101 shocks across the cohort in the 2 weeks before ablation.
  • Intravenous antiarrhythmic medications were successfully discontinued in all 5 patients receiving them prior to ablation, enabling hospital discharge in 4 of 6 patients.
  • Five patients died during follow-up (mean 228 ± 207 days post-procedure) from non-arrhythmic causes, while 1 patient remained alive at 1,205 days.

Structured PICO

Does endocardial VT ablation reduce VT burden and ICD shocks in patients with LVADs and refractory VT?

P
Population
6 patients with a left ventricular assist device (LVAD) and refractory ventricular tachycardia (VT)
I
Intervention
Endocardial ventricular tachycardia (VT) ablation
O
Outcome
Reduction in VT burden and ICD shocks, discontinuation of intravenous antiarrhythmic medications, and hospital dischargehard clinical

Endocardial VT ablation is feasible in LVAD patients with refractory VT and can significantly reduce VT burden, ICD shocks, and the need for intravenous antiarrhythmics, facilitating hospital discharge.

Cite This Study

Herweg et al. (2012) studied this question.

synapsesocial.com/papers/6a760c8449a8cdd61fb1ede0https://doi.org/10.1111/j.1540-8159.2012.03509.x

Topics

Ventricular arrhythmiasMechanical circulatory support
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Ablation of Left Ventricular Tachycardia via Transeptal Approach and Crossing of a Mechanical Mitral Valve Prosthesis2010 · 16 citations
  2. 2Percutaneous Endocardial and Epicardial Ablation of Hypotensive Ventricular Tachycardia with Percutaneous Left Ventricular Assist in the Electrophysiology Laboratory2006 · 54 citations
  3. 3Electrophysiological Alterations After Mechanical Circulatory Support in Patients With Advanced Cardiac Failure2001 · 145 citations
  4. 4Use of a Continuous-Flow Device in Patients Awaiting Heart Transplantation2007 · 1,740 citations
  5. 5Prolonged Sustained Ventricular Fibrillation without Loss of Consciousness in Patients Supported by a Left Ventricular Assist Device2002 · 29 citations