Clin Res Cardiol 108, Suppl 2, October 2019

Successful High Density VT Map with Coaxial Magnetic Assist Device Support

C. Fräbel1, R. Chasan1, N. Schneider1, V. Johnson1, C. W. Hamm1, J. Schmitt1

1Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Gießen;

We are showing the case of a 74 year old male patient presenting with the third relevant episode of  hemodynamically instable ventricular tachycardia (VT) (cycle length 420ms) originating from the posterior left ventricle. Due to the medical history of the patient he has been treated with long-term amiodarone in a primary centre, slowing down previous episodes of VT (initial CL 340ms). Previous medical history contains ischemic cardiomyopathy with left ventricular ejection fraction (LVEF) 20%,  coronary artery disease (LAD and RCA) and STEMI of the posterior wall with following reconstruction (Dor plastic) and coronary bypass grafts on LAD and RCA all in 2014. The patient presented with electrical storm 12/2018 (31 ICD therapies) and was referred to our centre 01/2019. After ruling out a relevant progress of CAD, decision to VT ablation was made. Due to severe ischemic cardiomyopathy these slow-VT episodes appeared as instable VT. In order to perform an activation and scar map we decided to perform the procedure with mechanical assist device support (MDS). We implanted an Impella® (2.5 device) in a stable pre-procedure setting via left femoral artery. High-density map was pursued, using the HD-Grid® catheter and the Ensite Precision® System. Although concerns on interactions and artefacts were present, no interferences of the used magnetic driven pump were observed neither on electrograms (in sinus rhythm as well as during VT) with excellent depiction of fractionation, nor with the electroanatomical map. VT could be mapped and ablated with non-inducibility as end point. This successful procedure encouraged us to perform this approach more frequently in these kind of patients, knowing about possible severe side effects from implanting mechanical assist devices.

https://www.abstractserver.com/dgk2019/ht/abstracts//P690.htm