Lessons learned from catheter ablation of ventricular arrhythmias in patients with a fully magnetically levitated left ventricular assist device,Clinical Research in Cardiology

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Lessons learned from catheter ablation of ventricular arrhythmias in patients with a fully magnetically levitated left ventricular assist device
Clinical Research in Cardiology ( IF 3.8 ) Pub Date : 2021-10-28 , DOI: 10.1007/s00392-021-01958-0
Leonard Bergau ₁ , Philipp Sommer _{1,

2} , Mustapha El Hamriti ₁ , Michel Morshuis _{2,

3} , Denise Guckel ₁ , René Schramm _{2,

3} , Sebastian V Rojas ₃ , Guram Imnadze ₁ , Jan F Gummert _{2,

3} , Christian Sohns ₁ , Henrik Fox _{2,

3}

Affiliation

Introduction

Data on catheter ablation of ventricular arrhythmias (VA) are scarce in patients with left ventricular assist devices (LVADs) and current evidence predominantly consists of case reports with outdated LVAD. This prospective observational study reports our experience in terms of catheter ablation of VAs in patients with novel 3^rd generation LVADs.

Methods and results

Between 2018 and 2020, nine consecutive patients undergoing a total number of ten ablation procedures for VAs were analyzed. The mean duration between LVAD implantation and catheter ablation was 23 ± 16 months. Acute procedural success was achieved in all patients. VA substrates were not related to the LVAD scarring (cannula) site in the majority of patients. All procedures were conducted without any relevant procedure-related complications. In terms of follow-up, only one patient presented with a repeat episode of electrical storm requiring ICD-shocks 16 months after the initial ablation procedure. Four patients suffered of singular VA effectively treated with antitachycardia pacing via their ICD. The remainder were free of any VA relapse (n = 4). Two non-procedure-related deaths occurred during follow-up.

Conclusions

Catheter ablation of VAs in patients with 3rd generation LVAD is feasible and leads to satisfying clinical results in terms of freedom from VA recurrence and quality of life. The majority of arrhythmia substrates in these patients are not directly related to the LVAD cannulation site and may represent a progress of heart failure.

Graphic abstract

中文翻译：

从完全磁悬浮左心室辅助装置患者的室性心律失常导管消融中吸取的经验教训

介绍

左心室辅助装置 (LVAD) 患者的室性心律失常 (VA) 导管消融数据很少，目前的证据主要包括过时 LVAD 的病例报告。^{这项前瞻性观察性研究报告了我们在新型第三}代 LVAD患者的 VA 导管消融方面的经验。

方法和结果

在 2018 年至 2020 年期间，分析了 9 名连续接受 10 次 VA 消融手术的患者。LVAD 植入和导管消融之间的平均持续时间为 23 ± 16 个月。所有患者均获得了急性手术成功。大多数患者的 VA 底物与 LVAD 瘢痕（套管）部位无关。所有程序均在没有任何相关程序相关并发症的情况下进行。在随访方面，只有一名患者在初次消融手术后 16 个月出现需要 ICD 电击的电风暴重复发作。4 名患有单一 VA 的患者通过 ICD 进行抗心动过速起搏有效治疗。其余的没有任何 VA 复发（n = 4）。随访期间发生了两例与手术无关的死亡。