(785) Successful Ventricular Tachycardia Ablation in a Patient with Biventricular Support Post Heartmate 3 Implantation

• Published in: The Journal of heart and lung transplantation Vol. 42; no. 4; p. S345
• Main Authors: Al-Abboud, O.A., Harada, R., Alom, M., Bhattal, G., Kabra, N., Rawitscher, D., Afzal, A., Yousif, A., George, T.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2023
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2023.02.799

Left ventricular assisted devices (LVAD) have increased survival and quality of life in patients with end stage heart failure. However, elimination of malignant arrhythmia in these patients remains challenging. Reportedly, 35% of patients with LVADs develop ventricular arrhythmias in the first month of implantation, often refractory to anti-arrhythmic agents, which can lead to profound RV failure. The application of catheter ablation of ventricular tachycardia (VT) has been widely adopted in patients with cardiomyopathy, but its application among patients with LVAD is limited. We present a case of successful catheter ablation of VT performed in a patient with LVAD with an RV assist device in place for severe RV failure. A 70-year-old male presented in acute biventricular heart failure. He was found to have multivessel coronary artery disease, deemed to be a nonsurgical candidate, and progressed to cardiogenic shock. Echocardiography showed an end-diastolic diameter of 7.9 cm and an ejection fraction of 10%. He was started on inotropic support but was soon escalated to Impella 5.5 due to hemodynamic deterioration. He developed episodes of non-sustained VT, treated with lidocaine and amiodarone infusions. Given the evidence of end-stage heart failure, the decision was to proceed with the LVAD implantation and intraoperative apical VT ablation. He continued to have recurring monomorphic VT episodes which worsened his RV function and he required RVAD support with 29Fr Protek Duo Cannula. After a multidisciplinary discussion, he underwent catheter-guided VT ablation while remaining on bi-ventricular hemodynamic support via LVAD and RVAD. Post-ablation, his arrhythmia subsided with subsequent improvement in RV function and his RVAD was weaned off. He clinically improved and was discharged home. Catheter-based VT ablation is a feasible and effective treatment for refractory VT in patients with LVAD and worsening RV failure while being on support with RVAD.