Concomitant surgical cryoablation for refractory ventricular tachycardia and left ventricular assist device placement: a
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CASE REPORT
Open Access
Concomitant surgical cryoablation for refractory ventricular tachycardia and left ventricular assist device placement: a dual remedy but a recipe for thrombosis? Colleen K. McIlvennan1*, Ashok N. Babu2, Andreas Brieke1 and Amrut V. Ambardekar1
Abstract Background: Ventricular tachycardia (VT) can persist following placement of a left ventricular assist device (LVAD). The optimal management strategy for VT during the peri-LVAD period is unknown. Case Presentations: Two case reports are presented that describe epicardial and endocardial VT ablation performed during LVAD placement. Subsequently, both patients developed LVAD thrombosis, a known and dreaded complication of LVADs, requiring re-operation. Conclusions: While LVAD thrombosis is likely multifactorial and remains an area of active research, these two cases should increase awareness of the possible risks of VT ablation—especially endocardial ablation—during LVAD placement. Further research is needed to understand the effects of VT ablation during the peri-LVAD period. Keywords: Heart-assist device, Heart failure, Ventricular tachycardia, Ablation
Background Left ventricular assist devices (LVADs) have the potential to improve survival and quality of life, yet complications are common—including ventricular tachycardia (VT) [1]. The ideal management strategy for VT peri-LVAD placement is unknown; however, there are isolated reports of performing concomitant surgical VT cryoablation at the time of LVAD placement with successful reduction in arrhythmia burden [2, 3]. In theory, there are advantages to performing such an open surgical ablation compared to percutaneous catheter based approaches including the ability to fully visualize the epicardial surface and left ventricular (LV) endocardium through the ventriculotomy that is required for LVAD inflow cannula placement. Herein, we present two cases of concomitant surgical epicardial and endocardial VT cryoablation prior to LVAD placement that resulted in
* Correspondence: [email protected] 1 Division of Cardiology, University of Colorado, School of Medicine, 12631 East 17th Avenue, B130, Aurora, CO 80045, Canada Full list of author information is available at the end of the article
successful treatment of VT, but were complicated by subsequent LVAD pump thrombosis (Table 1).
Case Presentation Case 1
A 70-year-old female with non-ischemic cardiomyopathy presented in cardiogenic shock with incessant monomorphic VT that required intravenous (IV) lidocaine and amiodarone to remain quiescent. Given her hemodynamics, an intra-aortic balloon pump was placed. She was stabilized over several days and was taken to the operating room where she underwent an open epicardial and endocardial VT ablation with cryoprobe. Pace activation mapping of the LV was performed until the patient’s morphologic VT was identified on the anterior lateral wall. Cryoablation at this site suppressed further VT development. Additional endocardial and epicardial ablation lines were performed to isolate t
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