HeartMate 3: new challenges in ventricular tachycardia ablation

Abstract

Aim To describe clinical characteristics, procedural details, specific challenges, and outcomes in patients with HeartMate3™ (HM3), a left ventricular assist device system with a magnetically levitated pump, undergoing ventricular tachycardia ablation (VTA). Methods and results Data were collected from patients with an HM3 system who underwent VTA in seven tertiary centres. Data included baseline patient characteristics, procedural data, mortality, and arrhythmia-free survival. The study cohort included 19 patients with cardiomyopathy presenting with ventricular tachycardia (VT) (53% with VT storm). Ventricular tachycardias were induced in 89% of patients and a total of 41 VTs were observed. Severe electromagnetic interference was present on the surface electrocardiogram. Hence, VT localization required analysis of intra-cardiac signals or the use of filter in the 40–20 Hz range. The large house pump HM3 design obscured the cannula inflow and therefore multi imaging modalities were necessary to avoid catheter entrapment in the cannula. A total of 32 VTs were mapped and were successfully ablated (31% to the anterior wall, 38% to the septum and only 9% to the inflow cannula region). Non-inducibility of any VT was reached in 11 patients (58%). Over a follow-up of 429 (interquartile range 101–692) days, 5 (26%) patients underwent a redo VT ablation due to recurrent VTA and 2 (11%) patients died. Conclusions Ventricular tachycardia ablation in patients with HM3 is feasible and safe when done in the appropriate setup. Long-term arrhythmia-free survival is acceptable but not well predicted by non-inducibility at the end of the procedure.

Electrical storm and catheter ablation of ventricular tachycardia days after left ventricular assist device implantation

“…11 Similar conclusions were drawn in a study by Nof et al on a cohort of 19 patients. 11 Although some authors hypothesized potential interference between LVAD and electroanatomical mapping systems 11,12 , we found no signi cant interferences during the procedure.…”

Management of patients with an electrical storm or clustered ventricular arrhythmias: a clinical consensus statement of the European Heart Rhythm Association of the ESC—endorsed by the Asia-Pacific Heart Rhythm Society, Heart Rhythm Society, and Latin-American Heart Rhythm Society

“…A theoretical risk of catheter entrapment in the LVAD cannula/impeller and considerable noise interference on surface ECG and mapping from HeartMate 3 should also be taken into account. 343 The mechanical haemodynamic support provided by the LVAD usually allows the advised transfer of patients to specialized centres experienced in the management of patients with LVADs and VA.…”

Contributions of Israel to the field of clinical cardiac electrophysiology and implantable devices

“…Finally, 3 important works dealing with VT ablation were published by the team of Sheba Medical Center. In a multicenter study of VT ablation in patients with The HeartMate3 (Abbott Laboratories, Chicago, IL), an LV assist device system with a magnetically levitated pump, Nof and coworkers 126 found that ablation in patients with HeartMate3 is feasible and safe when done in the appropriate setup. They concluded that long-term arrhythmia-free survival is acceptable but not well predicted by noninducibility at the end of the procedure.…”