Catheter Ablation of Ventricular Tachycardia in Patients With a Ventricular Assist Device: A Systematic Review of Procedural Characteristics and Outcomes

Abstract

Objectives: This is a systematic review summarizing the procedural characteristics and outcomes of ventricular assist device (VAD)-related ventricular tachycardia (VT) ablation.

Background: Drug-refractory VT refractory commonly develops post-VAD implantation. Procedural and outcome data come from small series or case reports.

Methods: An electronic search was performed using major databases. Primary outcomes were VT recurrence, mortality, and cardiac transplantation. Secondary endpoints were acute procedural success and procedural complications.

Results: Eighteen studies were included, with a total of 110 patients (mean age 59.6 ± 11 years, 89% men; VT storm 34%). Scar-related re-entry was the predominant mechanism of VT (90.3%) and cannula-related VT in 19.3% cases. Electroanatomical mapping interference occurred in 1.8% of cases; there were no reports of catheter entrapment. Noninducibility of clinical VT was achieved in 77.9%; procedural complications occurred in 9.4%. At a mean follow-up of 263.5 ± 267.0 days, VT recurred in 43.6%, 23.4% underwent cardiac transplant, and 48.1% died. There were no procedural-related deaths and no death was directly related to ventricular arrhythmia. In follow-up, there was a significant reduction in implantable cardioverter-defibrillator therapies or shocks (57.1% vs. 23.8%). Ablation allowed VT storm termination in 90% of patients.

Conclusions: VAD-related VT is predominantly related to pre-existing intrinsic myocardial scar rather than inflow cannula site insertion. Catheter ablation is a reasonable treatment strategy, albeit with expectedly high rate of recurrence, transplantation, and mortality related to severe underlying disease.

Keywords: BIVAD; LVAD; RVAD; catheter ablation; mechanical support; radiofrequency ablation; ventricular assist device; ventricular tachycardia.