Author + information
- Robert D. Anderson, MBBSa,
- Geoffrey Lee, MBChB, PhDa,
- Sohaib Virk, BMed/MDb,
- Richard G. Bennett, MBChBc,
- Christopher S. Hayward, BMedSc, MDd,
- Kavitha Muthiah, MBChB, PhDd,
- Jonathan Kalman, MBBS, PhDa and
- Saurabh Kumar, BSc(Med)/MBBS, PhDb,e,∗ ()
- aDepartment of Cardiology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Australia
- bDepartment of Cardiology, Westmead Hospital, Westmead, Australia
- cBristol Heart Institute, Bristol Royal Infirmary, Bristol, United Kingdom
- dHeart Failure and Transplant Unit, Department of Cardiology, St. Vincent’s Hospital, Darlinghurst, Australia
- eDepartment of Cardiology, Westmead Applied Research Centre, University of Sydney, Westmead, Australia
- ↵∗Address for correspondence:
Assoc. Prof. Saurabh Kumar, Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Darcy Road, Westmead, New South Wales 2145, Australia.
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.
- catheter ablation
- mechanical support
- radiofrequency ablation
- ventricular assist device
- ventricular tachycardia
Dr. Anderson has been supported by postgraduate scholarships co-funded by the National Health and Medical Research Council (NHMRC) and Royal Australasian College of Physicians NHMRC Woodcock Scholarships. Dr. Hayward has served as a consultant for Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received June 12, 2018.
- Revision received August 7, 2018.
- Accepted August 17, 2018.
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