Background

Left ventricular assist devices (LVAD) have emerged an important element in the management of end-stage heart failure as a bridge-to-transplantation or bridge-to-destination therapy. Recurrent ventricular tachycardia (VT) after implantation of LVAD is a relevant clinical problem possibly leading to hemodynamic impairment, right ventricular failure and an increase in mortality.

Aims

The present study analyses clinical and procedural outcome after VT ablation due to recurrent symptomatic tachycardia in patients with LVAD.

Methods

All consecutive patients with LVAD undergoing VT ablation between 08/2018 and 11/2021 were prospectively included into the study. Procedures were performed in general anaesthesia. Endocardial ablation was performed implementing a 3D-mapping system and a multipolar mapping catheter. Both, the right and left ventricle were reconstructed and comprehensive substrate ablation was performed targeting all low-voltage areas and abnormal electrograms. If sustained VT was present ablation of critical isthmus sites was performed according to entrainment mapping. Endpoint of ablation was non-inducibility of any VT after ablation and extensive substrate modification. All patients were followed in our outpatient clinic including device interrogation.

Results

Twelve consecutive patients were included into the study. All patients underwent endocardial VT ablation. Eleven patients were male (91.7%), mean age was 59.3±7.5 years. Seven patients (58.3%) suffered from dilative cardiomyopathy and 5 patients (41.7%) from ischemic cardiomyopathy. Eight patients (66.7%) presented in electrical storm. Acute procedural success was achieved in all patients undergoing VT ablation. No procedural related complications were observed. Mean follow-up duration was 343.3±230 days. VT recurrence was observed in 5 patients (41.7%). ICD therapy was observed in all patients. ATP was successful in 4 patients (90%). Only one patient received a single ICD shock due to recurrent VT with successful termination. During follow-up 3 patients (25%) died without association to recurrent VT 212.7±173.7 days after ablation. Three patients (25%) underwent successful heart transplantation 862±233.7 days after ablation.

Conclusion

VT ablation in patients with LVAD is safe and leads to acceptable clinical outcome. Effective tachycardia suppression or at least tachycardia reduction with symptomatic relief was observed in all patients.