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Open-chest epicardial ablation of ventricular tachycardia during a left ventricular assist device implantation: a case report

Fukuzawa, Koji Hisamatsu, Eriko Nakai, Hidekazu Okada, Kenji 神戸大学

2023.07

概要

Background: Ventricular arrhythmias (VAs) are common after a left ventricular assist device (LVAD) implantation. Further, the majority of post-LVAD ventricular tachycardias (VTs) are secondary to a preexisting cardiomyopathy substrate. Intraoperative ablation of patients with recurrent preoperative VTs may reduce post-LVAD VTs. Case summary: A 59-year-old female with advanced heart failure due to non-ischaemic cardiomyopathy (LV ejection fraction = 24%) and recurrent VTs was referred for an LVAD implantation as a bridge to a heart transplant (INTERMACS Profile-5A). The previous endocardial ablation failed due to an epicardial arrhythmogenic substrate. Therefore, open-chest epicardial mapping during the LVAD implantation was indicated and three target areas of the arrhythmogenic substrate were found, which were ablated by radiofrequency applications. To minimize the cardiopulmonary bypass time, cardiopulmonary bypass was initiated after ablation, and then, an LVAD was implanted. An additional 68 min was required for mapping and ablation. All procedures were performed without any complications, and the post-operative course was uneventful. Thereafter, no VT episodes were observed without any anti-arrhythmic drugs during a 15-month follow-up with LVAD support. Discussion: Intraoperative epicardial mapping and ablation during an LVAD implantation can play an important role in the management of LVAD recipients with recurrent VAs.

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Downloaded from https://academic.oup.com/ehjcr/article/7/7/ytad277/7205823 by Natural Science Lib of Kobe Univ user on 20 July 2023

Funding: The Section of Arrhythmia is supported by an endowment

from Abbott JAPAN, Boston Scientific JAPAN, and Medtronic Japan.

KF belongs to the Section. K.F. has received a scholarship donation

from Biotronik.

K. Fukuzawa et al.

...

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