Characterization of ventricular tachycardia ablation in end-stage heart failure patients with left ventricular assist device (CHANNELED registry).

AbstractO_ST_ABSBackgroundC_ST_ABSPatients 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). MethodsData 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. ResultsOverall, 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. ConclusionAlthough 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 knownVT 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 addsO_LIMost 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. C_LIO_LILVAD related technical challenges are present but seem to have little impact on procedural efficacy. No association of electromagnetic interference and LVAD model was observed. C_LIO_LIExtensive 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. C_LIO_LINeither 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. C_LI Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=118 SRC="FIGDIR/small/24316462v1_ufig1.gif" ALT="Figure 1"> View larger version (38K): org.highwire.dtl.DTLVardef@db2aa1org.highwire.dtl.DTLVardef@cbd358org.highwire.dtl.DTLVardef@1a03f05org.highwire.dtl.DTLVardef@1897cc4_HPS_FORMAT_FIGEXP M_FIG C_FIG