Effect of Ventricular Arrhythmia Ablation in Patients with Heart Mate II Left Ventricular Assist Devices

Aims: Patients with advanced heart failure are predisposed to VA, particularly following implantation of an LVAD. Few data exist assessing appropriate management strategies. This study aimed to assess the mechanism of ventricular arrhythmia (VA) in patients with advanced heart failure and the efficacy of ablative therapy both prior to and following left ventricular assist device (LVAD) implantation.

Methods and Results: We created a retrospective cohort of patients who underwent both VA ablation and HeartMate II (Thoratec, CA) LVAD implantation at Mayo Clinic (Rochester, MN). Patients were stratified based on whether they underwent VA ablation before or after LVAD implantation. A total of 9 patients underwent both LVAD implantation and VA ablation. Three underwent ablation prior to LVAD and 6 after LVAD. Of patients who underwent ablation prior to LVAD, mean number of VA’s (n=31 versus 91 versus 58), anti-tachycardia pacing (n=42 versus 69 versus 58), and defibrillation (n=2 versus 2 versus 1) tended to increase after ablation and decreased after LVAD implantation. In patients who underwent ablation after LVAD implantation, the burden of VA’s (n=79 versus 27), anti-tachycardia pacing (n=17 versus 12), and defibrillation (n=3 versus 2) decreased after ablation. Two of six patients had substrate related to the LVAD inflow cannula site.

Conclusions: In patients with progressive heart failure and LVAD implantation, ablation is associated with reduced rates of VA. In LVAD patients, only a minority of VA substrate were related to the inflow cannula site.