Characterization of ventricular tachycardia ablation in end-stage heart failure patients with left ventricular assist device (CHANNELED registry)
Authors: van den Bruck J.-H. , Hohendanner F. , Heil E. , Albert K. , Duncker D. , Estner H. , Deneke T. , Parwani A. , Potapov E. , Seuthe K. , Wörmann J. , Sultan A. , Schipper J.-H. , Eckardt L. , Doldi F. , Lugenbiel P. , Servatius H. , Thalmann G. , Reichlin T. , Khalaph M. , Guckel D. , Sommer P. , Steven D. , Lüker J. 
Published: November 2024

Abstract

Background

Patients with left-ventricular-assist-devices (LVAD) are at high risk for ventricular tachycardia (VT), and data on VT ablation in LVAD patients is scarce. This multicenter registry assessed the mechanism of VT, procedural parameters, and outcome of VT ablation in LVAD patients (NCT06063811).

Methods

Data of LVAD patients referred for VT ablation at 9 tertiary care centers were collected retrospectively. Parameters included VT mechanisms, procedural data, VT recurrence, and mortality.

Results

Overall, 69 patients (90% male, mean age 60.7±8.4 years) undergoing 72 catheter ablation procedures were included. Most procedures were conducted after intensification of antiarrhythmic drug (AAD) treatment (18/72; 25%) or after prior combination of ≥ 2 AADs (31/72; 43%). Endocardial low voltage areas were detected in all patients. 96 different VTs were targeted. The predominant mechanism was scar-related re-entry (76/96 VTs; 79%) and 19/96 VTs (20%) were related to the LVAD cannula. Non-inducibility of any VT was achieved in 28/72 procedures (39%). No LVAD related complication was observed. The extent of endocardial scar was associated with VT recurrence. Over a median follow-up of 283 days (IQR 70-587 days), 3/69 were lost to follow-up, 10/69 (14%) patients were transplanted, 26/69 (38%) died, and 16/69 (23%) patients were free from VT.

Conclusion

Although often a last resort, VT ablation in LVAD patients is feasible and safe when performed in experienced centers. These patients suffer from a high scar burden, and cardiomyopathy-associated rather than cannula-related scar seems to be the dominant substrate. VT recurrence after ablation is high, despite extensive treatment, and the overall prognosis of these patients is limited.

What is known

VT ablation in LVAD patients is one of the most complex procedures in interventional electrophysiology dealing with critically ill patients. These procedures are highly prone to technical difficulties and complications, potentially limiting procedural success and outcome.

What the study adds

Most LVAD patients requiring VT ablation have a history of ventricular arrhythmia prior to LVAD implantation, and scar-related re-entry is the predominant arrhythmogenic mechanism.

LVAD related technical challenges are present but seem to have little impact on procedural efficacy. No association of electromagnetic interference and LVAD model was observed.

Extensive low voltage areas were detected in most patients. Unlike in non-LVAD patients, LVAD patients showed no difference in endocardial scar between ICM and NICM.

Neither the type of cardiomyopathy nor the endpoint of non-inducibility but the extent of myocardial scar seems to predict VT recurrence in patients with LVAD.

Graphical abstract