The role of percutaneous left ventricular assist devices during ventricular tachycardia ablation

Abstract

Ventricular tachycardia (VT) is a common but serious arrhythmia that significantly adds to the morbidity and mortality of patients with structural heart disease. Percutaneous catheter ablation has evolved to be standard therapy to prevent recurrent implantable cardioverter defibrillator shocks from VT in patients on antiarrhythmia medications. Procedural outcomes in patients with structural heart disease are often limited by haemodynamically unstable VT. Although substrate- and pace-mapping techniques have become increasingly popular for VT ablation, these approaches can often times may not address inducible clinical and non-clinical VTs. Activation and entrainment mapping can help the operator target VT exit sites in a precise fashion minimizing the amount of radiofrequency ablation needed for a successful ablation. An evolving alternative strategy that allows induction and mapping of VT in the setting of severe cardiomyopathy and haemodynamic instability is through maintaining perfusion with a percutaneous ventricular assist device (pVAD). This review will discuss these pVAD technologies, distinguish technical applications of use, highlight the published clinical experience, provide a clinical approach for support device selection, and discuss use of these technologies with current mapping and navigational systems.