Safety and Feasibility of Open Chest Epicardial Mapping and Ablation of Ventricular Tachycardia During the Period of Left Ventricular Assist Device Implantation

Patel, Mehul; Rojas, Francia; Shabari, M.P.H. Farshad Raissi; Simpson, Fred A.; Cohn, William E.; Frazier, O.H.; Mallidi, F.R.C.S.C. Hari; Cheng, Fei-Hsin; Mathuria, Nilesh

doi:10.1111/jce.12839

Cited by 41 publications

(23 citation statements)

References 30 publications

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“…Patel et al described a series of five patients with recurrent VT who underwent open chest epicardial mapping and ablation between postoperative days 1 and 12 after LVAD implant. The patients’ thoracic cavities were left exposed, with only the overlying skin initially sutured, then retracted at the time of ablation.…”

Section: Discussionmentioning

confidence: 99%

“…The ability to more accurately identify either before or during LVAD implant those patients at high risk for developing postimplant VA may improve LVAD outcomes. Several case series have reported the feasibility of intraoperative or perioperative VT ablation, but are limited by a lack of systematic high‐density intraoperative mapping . The aims of the present study are: To describe the feasibility of a safe and expeditious intraoperative protocol for high‐density multielectrode mapping of the epicardial substrate. To investigate any relationships between epicardial voltage characteristics and incidence of postimplant VA.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…In both cases, patients underwent open surgical cryoablation at the time of LVAD implantation and subsequently developed LVAD thrombosis. Cryoablation during LVAD implantation has been reported to decrease post-operative ventricular arrhythmias in select patients without an increase in the rate of adverse events [ 2 – 4 ]. However, several of these reports were published prior to the heightened awareness of thrombosis risk generated from more recent publications regarding LVAD pump thrombosis [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Concomitant surgical cryoablation for refractory ventricular tachycardia and left ventricular assist device placement: a dual remedy but a recipe for thrombosis?

McIlvennan

Babu

Brieke

et al. 2016

J Cardiothorac Surg

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BackgroundVentricular tachycardia (VT) can persist following placement of a left ventricular assist device (LVAD). The optimal management strategy for VT during the peri-LVAD period is unknown.Case PresentationsTwo case reports are presented that describe epicardial and endocardial VT ablation performed during LVAD placement. Subsequently, both patients developed LVAD thrombosis, a known and dreaded complication of LVADs, requiring re-operation.ConclusionsWhile LVAD thrombosis is likely multifactorial and remains an area of active research, these two cases should increase awareness of the possible risks of VT ablation—especially endocardial ablation—during LVAD placement. Further research is needed to understand the effects of VT ablation during the peri-LVAD period.

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“…[ 28 ] This period represents another opportunity for epicardial mapping and ablation in patients with suspected epicardial VT or substrate. [ 29 ] Although adhesions limit percutaneous pericardial access after LVAD implantation, case reports have described ablation after LVAD implantation using lateral thoracotomy or subxiphoid approaches as has been described following non-LVAD cardiac surgery. [ 30 , 31 ]…”

Section: Vt Ablation In the Setting Of Left Ventricular Assist Devicementioning

confidence: 99%

Hybrid Catheter-Based and Surgical Techniques for Ablation of Ventricular Arrhythmias

Khalil

Siontis

Bagameri

et al. 2020

Arrhythmia &Amp; Electrophysiology Review

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Catheter ablation is a rapidly expanding and evolving field. The advent of interventional techniques and advances in technology have allowed catheter ablation to supplant antiarrhythmic surgery for ventricular arrhythmia treatment. However, issues related to access and energy delivery limit the use of catheter ablation in some cases. Hybrid catheter-based and surgical techniques represent a novel approach to overcome these limitations. The hybrid technique combines the strengths and minimises the limitations of either catheter or surgical ablation alone. There is a growing body of evidence in the literature supporting the safety and efficacy of the hybrid surgical technique. This review aims to provide an overview of hybrid surgical-catheter ablation for ventricular arrhythmia.

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Safety and Feasibility of Open Chest Epicardial Mapping and Ablation of Ventricular Tachycardia During the Period of Left Ventricular Assist Device Implantation

Abstract: Open-chest hybrid epicardial mapping and ablation for recurrent VT is feasible and can be considered in select patients during the period of LVAD implantation.

Cited by 41 publications

References 30 publications

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

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

Concomitant surgical cryoablation for refractory ventricular tachycardia and left ventricular assist device placement: a dual remedy but a recipe for thrombosis?

Hybrid Catheter-Based and Surgical Techniques for Ablation of Ventricular Arrhythmias

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