Ablation therapy for ventricular arrhythmias in patients with LVAD: Multiple faces of an electrophysiological challenge. Issue 3 (5th May 2021)

• Record Type: Journal Article
• Authors: Sisti, Nicolò; Santoro, Amato; Carreras, Giovanni; Valente, Serafina; Donzelli, Stefano; Mandoli, Giulia Elena; Sciaccaluga, Carlotta; Cameli, Matteo
• Is Part Of: Journal of arrhythmia. Volume 37:Issue 3(2021)
• Page Start: 535
• Page End: 543
• Publication Date: 2021-05-05
• Subjects: advanced heart failure -- catheter ablation -- left ventricular assist devices -- mechanical circulatory support -- ventricular arrhythmias; Arrhythmia -- Periodicals; Cardiac pacing -- Periodicals; Arrhythmias, Cardiac; Arrhythmia; Cardiac pacing; Periodicals; Electronic journals; Periodicals; 616.128
• DOI: 10.1002/joa3.12542
• Languages: English
• ISSNs: 1880-4276

Abstract

Abstract: Left ventricular assist device implantation is a recognized treatment option for patients with advanced heart failure refractory to medical therapy and can be used both as bridge to transplantation and as destination therapy. The risk of ventricular arrhythmias is common after left ventricular assist device implantation and is influenced by pre‐, peri and post‐operative determinants. The management of ventricular arrhythmias can be a challenge when they become refractory to medication or to device therapy and their impact on prognosis can be detrimental despite the mechanical support. In this setting, catheter ablation is being increasingly recognized as a feasible option for patients in which standard therapeutic strategies fail, but also with preventive purpose. Catheter ablation is being increasingly considered for the management of ventricular arrhythmias in patients with left ventricular assist device despite complex clinical and technical peculiarities due to the characteristics of the mechanical support. Much conflicting data exist regarding the predictors of success of the procedure and the rate of recurrence. In this review we discuss the latest evidences regarding catheter ablation of ventricular arrhythmias in this subset of patients, focusing on clinical characteristics, arrhythmia etiology, technical aspects and postprocedural features which must be considered by the electrophysiologist. Abstract : Ventricular arrythmias have a significant prognostic impact in patients with LVAD. Catheter ablation in patients with LVAD is a feasible option when first line therapy fails. Mapping can be challenging due to mechanical and electromagnetic limitations. Complications can be reduced through a careful pre‐procedural planning.