Catheter Ablation -> Ventricular Arrhythmias -> Clinical Trials / Outcomes D-PO05 - Poster Session V (ID 39) Poster

D-PO05-204 - Ventricular Tachycardia Ablation In Patients With Continuous Flow Left Ventricular Assist Device (ID 594)

Abstract

Background: Little is known about ventricular tachycardia (VT) ablation in patients with continuous-flow left ventricular assist device (cf-LVAD)
Objective: Report the procedural profiles and outcomes of VT ablation in patients with cf-LVAD
Methods: Patients were identified from a prospectively maintained registry of all patients undergoing VT ablation (2010-2017). Care was taken to avoid catheter entrapment in inflow cannula with using intracardiac echo, fluoroscopy, and 3D mapping.
Results: A total of 14 VT ablations in 11 patients with cf-LVAD were identified (median age 62, 9 males, median EF 20%, non-ischemic in 73%). The LVAD was a bridge to transplant in 7 patients (64%), implanted during same admission in 6 patients, while existing prior to admission in the remaining. Endocardial voltage maps showed myocardial scar in 9 cases (3 anterior, 2 lateral, 1 anterolateral, 1 septal, 1 apical, 1 inferoseptal). VT was inducible in 11 cases (79%), with a median of 1 VT per case (IQR 1-4). The clinical VTs were inducible in 10 patients (71%), whereas 2 cases were PVC induced VF/VT (14%), and in the remaining 2 cases the clinical VTs were non-inducible. In those with inducible clinical VTs, activation mapping was possible in all 10, and entrainment was done in 4. In 1 case of PVC induced VF, the PVC was mapped to the inflow cannula site, while in all other cases the clinical arrhythmia was unrelated to the inflow cannula. In addition to targeting the clinical VTs, 15 non-clinical VTs were also ablated, and substrate modification was performed in 6 cases were scar was present (67%). After ablation and scar modification, arrhythmia was inducible in only 2 of 12 cases (procedure terminated due to suspected epicardial VT focus). There were no procedure-related complications. In all, ventricular arrhythmias recurred in 7 cases, leading to repeat ablation in 3 of them. All 11 patients survived beyond 6 months and 8 (73%) survived beyond 1 year. Six patients (55%) subsequently received heart transplant. No catheter entrapment was encountered.
Conclusion: VT ablation is safe and feasible in LVAD patients (mostly not related to inflow cannula) and is associated with good 6-month and 1 year survival but with high rates of subsequent ventricular arrhythmia, likely reflecting poor substrate.
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