Ventricular arrhythmias following continuous‐flow left ventricular assist device implantation: A systematic review

Gordon, John H.; Maynes, Elizabeth J.; Choi, Jae Hwan; Wood, Chelsey T.; Weber, Matthew P.; Morris, Rohinton J.; Massey, H. Todd; Tchantchaleishvili, Vakhtang

doi:10.1111/aor.13665

Cited by 22 publications

(28 citation statements)

References 42 publications

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“…Up to 37% of patients might develop ventricular arrhythmias. 2 In LVAD patients, VTs are tolerated as the circulation is being kept up by the device. However, the patients experience weakness and dizziness without loss of consciousness.…”

Section: Discussionmentioning

confidence: 99%

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Video assisted thoracoscopic sympathectomy for intractable recurrent VT after minimal‐invasive LVAD implantation

et al. 2020

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Background Recurrent ventricular tachycardia (VT) can occur after left ventricular assist device (LVAD) implantation. In this case, medical treatment might be insufficient. We report a case of a left‐sided thoracoscopic sympathectomy as a feasible treatment escalation in intractable VT. Case Report A 72‐year‐old patient underwent an internal cardioverter defibrillator (ICD) implantation as primary prophylaxis for VTs in the setting of staged heart failure therapy. Afterwards, due to a progressive dilative cardiomyopathy he underwent a minimal‐invasive LVAD implantation (HeartWare, Medtronic). After an uneventful minimal‐invasive LVAD‐implantation the patient was discharged to a rehabilitation program. However, after 7 weeks he developed recurrent VTs which were successfully terminated by ICD shocks deliveries leading to severe discomfort and frequent hospitalizations. Eventually, the patient was admitted with an electrical VT storm. Successful endocardial catheter ablation of all inducible VTs were performed combined with multiple rearrangements of his oral antiarrhythmic medication. However, all these treatments could not suppress further occurrence of VTs. After an interdisciplinary discussion the patient agreed to a left‐sided video‐assisted thoracoscopic sympathectomy. After a follow up of 150 days the patient was free from VTs apart from one short event. Conclusion We believe video‐assisted thoracoscopic sympathectomy might be a surgical treatment option in patients with intractable recurrent VTs after catheter ablation of VT reentrant substrate even after minimal‐invasive LVAD implantation.

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Section: Discussionmentioning

confidence: 99%

“…Postoperative complications in LVAD implantation include bleeding, infection, device failure, multiorgan failure, neurological events, right heart failure, and arrhythmia. Up to 37% of patients might develop ventricular arrhythmias 2 . In LVAD patients, VTs are tolerated as the circulation is being kept up by the device.…”

Section: Discussionmentioning

confidence: 99%

Video assisted thoracoscopic sympathectomy for intractable recurrent VT after minimal‐invasive LVAD implantation

et al. 2020

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“…The mechanisms triggering VAs span from subendocardial ischemia, myocytes remodeling and fibrosis, inotropes, electrolytes disturbances, mechanical contact with the device and inflow cannula‐related scar 12,25 . The analysis of Gordon et al and Enriquez et al points at monomorphic sustained ventricular tachycardia (VT) as the most recurrent arrhythmia (nearly 85% of cases), followed by ventricular fibrillation (VF) (31% of cases) 3,26 . The reported prevalence of inflow cannula related VAs is variable, ranging from 14% to 43%, since the same patients often have an intrinsic apical scar which makes difficult the recognition of the precise origin of the circuit 15,27,28 .…”

Section: Etiology Of Ventricular Arrhythmias In Lvad Patientsmentioning

confidence: 99%

“…Ventricular assist devices (VADs) represent a consolidated strategy used either as a bridge to cardiac transplantation or as destination therapy for nontransplant candidates 1 . The incidence of ventricular arrhythmias (VAs) in patients with advanced heart failure reaches 5% and this burden persists with an upward trend after left ventricular assist device (LVAD) implantation 2,3 . Around 28%–52% of patients with LVAD experience episodes of sustained VAs after implantation, with some authors considering those as the second most common post‐procedural complication 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Ablation therapy for ventricular arrhythmias in patients with LVAD: Multiple faces of an electrophysiological challenge

Sisti

Santoro

Carreras

et al. 2021

Journal of Arrhythmia

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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.

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“…Another arrhythmia that closely accompanies the LVAD population is ventricular tachycardia (VT). It is estimated that approximately one third of patients develop ventricular arrhythmias after continuous-flow LVAD implantation 41. Thereby, a recent survey aimed to measure PT, stroke, and embolic event rates after VT ablation.…”

mentioning

confidence: 99%

Left Ventricular Assist Device-Related Complications

Clément¹,

Anghel

Sascău

et al. 2020

Journal of Cardiovascular Emergencies

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Left ventricular assist device (LVAD) has emerged as a safe, durable, and revolutionary therapy for end-stage heart failure patients. Despite the appearance of newer-generation devices that have improved patient outcomes, the burden of adverse events remains significant. Although the survival rate for patients with LVAD is appreciated to be 81% at 1 year and 70% at 2 years, the incidence of adverse events is also high. Over time, both early and late postimplant complications have diminished in terms of prevalence and impact; however, complications, such as infections, bleeding, right heart failure, pump thrombosis, aortic insufficiency, or stroke, continue to represent a challenge for the practitioner. Therefore, the aim of this review is to highlight the most recent data regarding the current use of LVAD in the treatment of end-stage heart failure, with a specific focus on LVAD-related complications, in order to improve device-related outcomes. It will also revise how to mitigate the risk and how to approach specific adverse events. Withal, understanding the predisposing risk factors associated with postimplant complications, early recognition and appropriate treatment help to significantly improve the prognosis for patients with end-stage heart failure.

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Ventricular arrhythmias following continuous‐flow left ventricular assist device implantation: A systematic review

Cited by 22 publications

References 42 publications

Video assisted thoracoscopic sympathectomy for intractable recurrent VT after minimal‐invasive LVAD implantation

Video assisted thoracoscopic sympathectomy for intractable recurrent VT after minimal‐invasive LVAD implantation

Ablation therapy for ventricular arrhythmias in patients with LVAD: Multiple faces of an electrophysiological challenge

Left Ventricular Assist Device-Related Complications

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