HeartMate 3: new challenges in ventricular tachycardia ablation
Eyal Nof1,2, Petr Peichl3, Predrag Stojadinovic3
1Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel.
Summary
Ventricular tachycardia ablation in HeartMate3™ (HM3) left ventricular assist device patients is feasible and safe. Long-term outcomes are acceptable, though procedural success doesn't fully predict arrhythmia-free survival.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Left ventricular assist devices (LVADs) like HeartMate3™ (HM3) are crucial for heart failure management.
- Ventricular tachycardia (VT) is a significant complication in LVAD recipients.
- Ventricular tachycardia ablation (VTA) is a potential treatment for refractory VT in these patients.
Purpose of the Study:
- To evaluate the feasibility, safety, and outcomes of VTA in patients with an HM3 LVAD.
- To describe procedural challenges and specific techniques employed during VTA in this population.
Main Methods:
- Retrospective analysis of 19 patients with HM3 undergoing VTA across seven centers.
- Data collected included patient demographics, procedural details, VT characteristics, and clinical outcomes.
- Specialized techniques were used for VT localization and ablation due to HM3 device interference and design.
Main Results:
- VTA was performed in patients with cardiomyopathy and VT (53% with VT storm).
- Severe electromagnetic interference required advanced signal analysis for VT mapping.
- Successful ablation of mapped VTs was achieved in 32 cases, with 58% achieving non-inducibility.
- Follow-up showed 26% required redo ablation, and 11% mortality.
Conclusions:
- VTA in HM3 LVAD patients is feasible and safe with appropriate setup.
- Long-term arrhythmia-free survival is acceptable but not reliably predicted by acute procedural success.
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