Successful treatment of ventricular arrhythmic storm with percutaneous coronary intervention and catheter ablation in a patient with left ventricular assist device.

INTRODUCTION

Ventricular arrhythmias are common in patients with advanced heart failure, which may also persist after sufficient intensive therapy for heart failure even with a left ventricular assist device. Although most ventricular arrhythmias have no hemodynamic relevance during left ventricular assist device support, some patients suffer from right ventricular decompensation due to ventricular arrhythmias resulting in severe hemodynamic deterioration and poor clinical outcomes.

METHODS

We describe herein an left ventricular assist device patient with refractory ventricular arrhythmic storm early after left ventricular assist device implantation.

RESULTS

The patient was admitted to our department after stenting of left anterior descending artery with subsequent polymorphic ventricular tachycardia and cardiogenic shock with ongoing multi-organ failure. After 6 days of extracorporeal life-support, a permanent left ventricular assist device was implanted. With postoperatively ongoing tachycardias, a subtotal right coronary artery occlusion was recanalized utilizing a drug-eluting stent. On the first post-intervention day, an additional catheter ablation was successfully performed. No further ventricular tachycardias were detected during the entire hospital stay and the further postoperative course was uneventful. The patient was transferred to a physiotherapy unit to improve his daily physical activities. He is currently at home and doing well 6 months after discharge.

CONCLUSIONS

Our case report demonstrates the feasibility of a successful therapeutic approach with a combination of interventional therapies such as coronary stenting and catheter ablation in a patient with persistent ventricular arrhythmias after assist device implantation.