Abstract
Catheter ablation is an effective treatment for ventricular tachycardia (VT) in structural heart disease to reduce VT recurrence and implantable cardioverter defibrillator shocks.Current guidelines recommend ablation in patients with recurrent or incessant VT. In patients with left ventricular assist device (LVAD), VTs may be well tolerated hemodynamically and catheter ablation has been performed rarely, until now. We present a case of successful VT ablation in a patient with LVAD and electrical storm. Effective ablation after a transseptal LV access was achieved using electroanatomic mapping and a substrate-based approach. On the basis of this case, we discuss the pros and cons of VT ablation in these patients.
Zusammenfassung
Bei Patienten mit struktureller Herzerkrankung und ventrikulären Tachykardien (VT) ist die Katheterablation eine effektive Behandlungsmaßnahme, um das Wiederauftreten von VT und ICD-Schocks zu reduzieren. Die aktuellen Leitlinien empfehlen die Ablation bei wiederholten oder unaufhörlich laufenden Kammertachykardien. Bei Patienten mit linksventrikulärem Unterstützungssystem (LVAD) können VT hämodynamisch gut toleriert sein, und die Katheterablation wurde bisher nur zurückhaltend eingesetzt. Wir stellen den Fall eines Patienten mit LVAD vor, der nach mehrjähriger Geschichte von ICD-Schocks mit einem elektrischen Sturm zugewiesen wurde und über einen transseptalen Zugang effektiv abladiert werden konnte. Anhand dieses Falls soll das Für und Wider einer frühzeitigeren VT-Ablation bei diesen Patienten diskutiert werden.
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Conflict of interest. A. Schade, K. Nentwich, and T. Deneke state that there are no conflicts of interest.
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Schade, A., Nentwich, K. & Deneke, T. Catheter ablation of electrical storm in a patient with left ventricular assist device. Herzschr Elektrophys 25, 102–104 (2014). https://doi.org/10.1007/s00399-014-0311-0
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DOI: https://doi.org/10.1007/s00399-014-0311-0