Effect of Ventricular Arrhythmia Ablation in Patients With Heart Mate II Left Ventricular Assist Devices: An Evaluation of Ablation Therapy

Snipelisky, David; Reddy, Yogesh N.V.; Manocha, Kevin K.; Patel, Ankit D.; Dunlay, Shannon M.; Friedman, Paul A.; Munger, Thomas M.; Asirvatham, Samuel J.; Packer, Douglas L.; Cha, Yong‐Mei; Kapa, Suraj; Brady, Peter A.; Noseworthy, Peter A.; Maleszewski, Joseph J.; Mulpuru, Siva K.

doi:10.1111/jce.13114

Cited by 25 publications

(21 citation statements)

References 19 publications

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“…Indeed, multiple studies reported that the majority of ventricular arrhythmias ablated in the LVAD population are related to scar remote form the LVAD canula. (10)(11)(12)(13). While pre-LVAD was an independent predictor of late post LVAD VA, early post LVAD VA was not after adjusting for pre-LVAD VA.…”

Section: Discussionmentioning

confidence: 82%

Association Between Early Ventricular Arrhythmias and Mortality in Destination Vs. Bridge Patients on Continuous Flow LVAD Support

Jedeon

Cogswell

Schultz

et al. 2021

Preprint

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Background: The association between ventricular arrhythmias (VAs) and mortality in patients supported by continuous flow left ventricular assist devices (LVAD) remains controversial. Objective: To evaluate the association between pre-implantation, early (≤30 day) post-implantation VAs and mortality in bridge to transplant (BTT) and destination therapy (DT) LVAD patients, separately. The risk factors for post LVAD VAs were also investigated.Methods: In this observational cohort study, we included 341 patients who received a first time, continuous flow LVAD between January 1st 2010 and July 30th 2018. We used Kaplan Meier curves and multivariable cox regression analyses to study the association between VAs and mortality in the BTT and DT populations.Results: The mean age of the cohort was 58 ± 14 years, with 82% males, 53% had ischemic cardiomyopathy, and 45% were DT. The mean follow-up was 2.2 ± 2.1 years. In both BTT and DT cohorts, pre LVAD VAs were not associated with mortality after LVAD implantation (log-rank p=0.95 and p=0.089, respectively). In the BTT population, early post-LVAD VAs were not statistically associated with increased mortality (log rank p=0.072). In the DT patients, early post LVAD VAs were associated with a 67 % increase in the hazards rate of mortality on LVAD support (HR 1.67 [1.05-2.65], p=0.029). The final model was adjusted for type of cardiomyopathy, INTERMACS profile, glomerular filtration rate, post LVAD atrial fibrillation, age and cerebrovascular events.Conclusion: Early post-LVAD VA is common after LVAD implantation and is an independent predictor of mortality in the DT LVAD population.

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Section: Discussionmentioning

confidence: 82%

Association Between Early Ventricular Arrhythmias and Mortality in Destination Vs. Bridge Patients on Continuous Flow LVAD Support

Jedeon

Cogswell

Schultz

et al. 2021

Preprint

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“…Elsewhere, while LVAD therapy has emerged as a promising option to improve survival in patients with endstage heart failure, it has been repeatedly reported that LVADs may actually increase the VA burden. 4 In a single-center retrospective analysis of 43 patients who underwent implantation of a HeartMate™ II LVAD (Abbott Laboratories, Chicago, IL, USA), 27.9% experienced early electrical storm, defined as three or more ICD therapy applications in 24 hours, with a median time from LVAD implant of 9.1 days ± 7.8 days. Those who had early VT also had a significantly higher all-cause mortality rate at 30 days (33.3% versus 6.5%).…”

Section: Discussionmentioning

confidence: 99%

“…However, it is well-recognized that ventricular arrhythmia (VA) burden may actually rise following the implantation of an LVAD, 2 which is associated with a decrease in patient survival. 3 Catheter ablation for recurrent, drug-refractory ventricular tachycardia (VT) in patients with structural heart disease is well-established, [4][5][6] resulting in fewer appropriate implantable cardioverter-defibrillator (ICD) shocks and repeat hospitalizations. In this report, we discuss the case of a patient with drug-refractory VA following LVAD placement that was successfully mapped and terminated with catheter ablation.…”

Section: Introductionmentioning

confidence: 99%

Ventricular Tachycardia Ablation in Patients with Left Ventricular Assist Devices

Patil

Chrispin

2019

J Innov Cardiac Rhythm Manage

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“…With the older generation HeartMate LVAD, VA after LVAD placement was thought to involve substrate around the apical inflow cannula in many cases, but analysis was largely based on 12 lead EKG localization . Small, early series of endocardial VT ablation after LVAD placement suggested that VT is not associated with the apical inflow cannula in a majority of cases . More recent, larger series including continuous flow LVAD models have confirmed that late VT is often associated with pre‐existing intrinsic scar remote from the inflow cannula, and catheter ablation in these areas terminates over half of induced VT, whereas cannula‐associated arrhythmia accounted for only 9% to 24% of cases …”

Section: Discussionmentioning

confidence: 99%

“…Postimplant VA has been associated with right HF and increased mortality, and they are more prevalent in patients with older age, nonischemic cardiomyopathy (NICM), preoperative VA, and atrial fibrillation (AF) . Several studies have demonstrated the feasibility of endocardial mapping and ablation after LVAD placement . However, ventricular tachycardia (VT) ablation post‐LVAD can be limited by the inability to safely obtain percutaneous epicardial access, and VT recurrence rates after endocardial ablation are between 24% and 38%.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and utility of intraoperative epicardial scar characterization during left ventricular assist device implantation

Moss

Oesterle

Raiman

et al. 2018

Cardiovasc electrophysiol

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Introduction: Ventricular arrhythmias (VA) after left ventricular assist device (LVAD) placement are associated with increased morbidity and mortality.We sought to assess epicardial voltage characteristics at the time of LVAD implantation and investigate relationships between scar burden and postimplant VA. Methods and Results: Consecutive patients underwent open chest epicardial electroanatomic mapping immediately before LVAD implantation. Areas of low voltage and sites with local abnormal potentials were identified. Patients were followed prospectively for postimplant VA and clinical outcomes. Between 2015 and 2017, 36 patients underwent high-density intraoperative epicardial voltage mapping; 15 had complete maps suitable for analysis. Mapping required a median of 11.8 (interquartile range [IQR], 8.5-12.7) minutes, with a median of 2650 (IQR, 2139-3191) points sampled per patient. Over a median follow-up of 311 (IQR, 168-469) postoperative days, four patients (27%) experienced sustained VA. Patients with postimplant VA were more likely to have had preimplant implantable cardioverter defibrillator shocks (100% vs 27%; P = 0.03), ventriculartachycardia storm (75% vs 9%; P = 0.03), and lower ejection fraction (13.5 vs 19.0%, P = 0.05). Patients with postimplant VA also had a significantly higher burden of epicardial low bipolar voltage points: 55.4% vs 24.9% of points were less than 0.5 mV (P = 0.01), and 88.9% vs 63.7% of points less than 1.5 mV (P = 0.004).Conclusions: Intraoperative high-density epicardial mapping during LVAD implantation is safe and efficient, facilitating characterization of a potentially arrhythmogenic substrate. An increased burden of the epicardial scar may be associated with a higher incidence of postimplant VA. The role of empiric

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Effect of Ventricular Arrhythmia Ablation in Patients With Heart Mate II Left Ventricular Assist Devices: An Evaluation of Ablation Therapy

Abstract: In patients with progressive HF and LVAD implantation, ablation is associated with reduced VA rates. In LVAD patients, most VAs arise from substrate unrelated to the inflow cannula site.

Cited by 25 publications

References 19 publications

Association Between Early Ventricular Arrhythmias and Mortality in Destination Vs. Bridge Patients on Continuous Flow LVAD Support

Association Between Early Ventricular Arrhythmias and Mortality in Destination Vs. Bridge Patients on Continuous Flow LVAD Support

Ventricular Tachycardia Ablation in Patients with Left Ventricular Assist Devices

Feasibility and utility of intraoperative epicardial scar characterization during left ventricular assist device implantation

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