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Catheter Ablation for Ventricular Tachyarrhythmias in Patients Supported by Continuous-Flow Left Ventricular Assist Devices

Garan, Arthur R.*; Iyer, Vivek*; Whang, William*; Mody, Kanika P.*; Yuzefpolskaya, Melana*; Colombo, Paolo C.*; Te-Frey, Rosie; Takayama, Hiroo; Naka, Yoshifumi; Garan, Hasan*; Jorde, Ulrich P.*; Uriel, Nir*

doi: 10.1097/MAT.0000000000000061
Clinical Cardiovascular

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.

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.

Submitted for consideration October 21, 2013; accepted for publication in revised form February 3, 2014.

Ulrich P. Jorde contributed equally as senior author.

Disclosure: Dr. Naka is a consultant for Terumo Heart Inc., Thoratec Corp., and Cardio-MEMS. Dr. Jorde has received consulting fees from Thoratec Corp. Dr. Uriel has received consulting fees from Heartware, Inc. The other authors have no conflicts of interest to report.

Reprint Requests: Nir Uriel, MD, Mechanical Circulatory Support Program, Division of Cardiology, Columbia University Medical Center–New York-Presbyterian Hospital, 622 West 168th Street, PH-12, Room 134, New York, NY 10032. Email: urielnir@gmail.com, nu2126@columbia.edu.

Copyright © 2014 by the American Society for Artificial Internal Organs