Contemporary Outcomes of Ventricular Tachycardia Ablation in Left Ventricular Assist Device Therapy: A Meta-Analysis

Ventricular arrhythmias (VAs) remain a pervasive and deadly arrhythmia in patients with left ventricular assist devices (LVADs). Catheter ablation has emerged as a treatment option for refractory VAs, yet evidence in the era of the HeartMate 3 (HM3) remains limited. This review aims to synthesize contemporary evidence for VA ablation in LVAD recipients.

A systematic review was performed across major electronic databases. The primary efficacy outcome was the recurrence of ventricular tachycardia (VT), and the primary safety outcome was the rate of procedural complications. The secondary outcomes were inability to induce any VT, all-cause mortality at 12 months, orthotropic heart transplantation (OHT). Sub-analyses were performed for patients with HM3 LVADs.

Twenty-seven studies encompassing 300 LVAD recipients undergoing 325 VT ablations, after a mean follow-up of 327 ± 175 days post VT ablation, VT recurred in 38% (95% CI, 28% to 49%) of cases and the complication rate was 8% (95% CI, 1.6% to 15.7%). VT was non-inducible in 61% of cases. One-year all-cause mortality was 26%, and 16% had OHT. Among HM3 recipients, electromagnetic interference (EMI) occurred in 51%, and no cases of device thrombosis were reported; one stroke was observed.

Catheter ablation is a safe and feasible treatment for refractory VAs in LVAD patients as evidenced by low complication rates and reasonable acute success. Yet, the persistence of considerable VT recurrence and all-cause mortality reflects the clinical complexity of this population. Procedural challenges include mapping limitations caused by EMI, particularly in the HM3 era.