Successful radiofrequency ablation therapy for intractable ventricular tachycardia with a ventricular assist device
ABSTRACT Refractory ventricular tachycardia (VT) can be a potentially life-threatening rhythm in the presence of non-ischemic dilated cardiomyopathy, particularly when it results in hemodynamic compromise. A 65-year-old man with non-ischemic cardiomyopathy was referred for multiple episodes of VT. A HeartMate left ventricular assist device (LVAD) was implanted to stabilize and control the VT. However, he had multiple episodes of VT and the frequency of ventricular arrhythmias did not improve after LVAD implantation. He required electrical cardioversion to treat each episode. On Day 41 post-operatively, radiofrequency ablation was performed. Two significant areas of scarring were identified and were successfully ablated. After ablation, he did not have significant sustained VT episodes and was discharged.
Heart Rhythm 08/2014; 11(10). DOI:10.1093/europace/euu194 · 4.92 Impact Factor
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ABSTRACT: Ventricular arrhythmias (VA) are common following implantation of a left ventricular assist device (LVAD) and in a subset of patients may be refractory to medication. Morbidity from VA in this population includes right ventricular failure (RVF). We sought to evaluate the efficacy of catheter ablation for VA in LVAD patients.A retrospective analysis of patients supported by continuous flow LVAD referred for catheter ablation of ventricular tachycardia (VT) between 2008 and the present was performed. Seven patients were referred for VT ablation an average of 236 ± 292 days following LVAD implantation. Three (42.9%) developed RVF in the setting of intractable arrhythmias. A transfemoral approach was used for 6 (85.7%) patients and an epicardial for 1 (14.3%). The clinical VT was inducible and successfully ablated in 6 (85.7%) patients. The location of these arrhythmias was apical in 3 (42.9%) cases. A total of 13 VTs were ablated in 7 patients. While the majority had reduction in VA frequency, recurrent VA were observed in 6 (85.7%) patients. One (14.3%) patient experienced a bleeding complication following the procedure.For patients with a high VA burden following LVAD implantation, VT ablation is safe and feasible, but VA frequently recur.ASAIO journal (American Society for Artificial Internal Organs: 1992) 03/2014; 60(3). DOI:10.1097/MAT.0000000000000061 · 1.39 Impact Factor
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ABSTRACT: Monomorphic ventricular tachycardia (VT) in patients with post-infarction cardiomyopathy (CMP) is caused by reentry through slowly conducting tissue with in areas of myocardial scar. The use of implantable cardioverter-defibrillators (ICDs) has helped to decrease the risk of arrhythmic death in patients with post-infarction CMP, but the symptomatic and psychological burden of ICD shocks remains significant. Experience with catheter ablation has progressed substantially in the past 20 years, and is now routinely used to treat patients with post-infarction CMP who experience VT or receive ICD therapy. Depending on the hemodynamic tolerance of VT, a variety of mapping techniques may be used to identify sites for catheter ablation, including activation and entrainment mapping for mappable VTs, or substrate mapping for unmappable VTs. In this review, we discuss the pathophysiology of VT in post-infarction CMP patients, and the contemporary practice of catheter ablation.Korean Circulation Journal 07/2014; 44(4):210-7. DOI:10.4070/kcj.2014.44.4.210