title: Catheter ablation for ventricular tachyarrhythmias in patients supported by continuous-flow left ventricular assist devices.
abstract: Ventricular arrhythmias (VAs) are common after 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 patients with LVAD. 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 after LVAD implantation. Three patients (42.9%) developed RVF in the setting of intractable arrhythmias. A transfemoral approach was used for six patients (85.7%) and an epicardial for one patient (14.3%). The clinical VT was inducible and successfully ablated in six patients (85.7%). The location of these arrhythmias was apical in three cases (42.9%). A total of 13 VTs were ablated in seven patients. Although the majority had reduction in VA frequency, recurrent VAs were observed in six patients (85.7%). One patient (14.3%) experienced a bleeding complication after the procedure. For patients with a high VA burden after LVAD implantation, VT ablation is safe and feasible, but VA frequently recurs.
authors.affiliation: From the *Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York; and †Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Garan
authors.forename: Vivek
authors.initials: V
authors.lastname: Iyer
authors.forename: William
authors.initials: W
authors.lastname: Whang
authors.forename: Kanika P
authors.initials: KP
authors.lastname: Mody
authors.forename: Melana
authors.initials: M
authors.lastname: Yuzefpolskaya
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.forename: Rosie
authors.initials: R
authors.lastname: Te-Frey
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.forename: Hasan
authors.initials: H
authors.lastname: Garan
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D017147:Defibrillators, Implantable; D004594:Electrophysiology; D006333:Heart Failure / Q000601:surgery / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology*; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006470:Hemorrhage; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000628:therapy*; D016896:Treatment Outcome