van den Bruck Jan-Hendrik, Hohendanner Felix, Heil Emanuel, Albert Karolin, Duncker David, Estner Heidi, Deneke Thomas, Parwani Abdul, Potapov Evgenij, Seuthe Katharina, Wörmann Jonas, Sultan Arian, Schipper Jan-Hendrik, Eckardt Lars, Doldi Florian, Lugenbiel Patrick, Servatius Helge, Thalmann Gregor, Reichlin Tobias, Khalaph Moneeb, Guckel Denise, Sommer Philipp, Steven Daniel, Lüker Jakob
Department for Electrophysiology, Heart Centre University Hospital of Cologne, Kerpener Strasse 62, Cologne 50937, Germany.
Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany.
Europace. 2025 Mar 28;27(4). doi: 10.1093/europace/euaf054.
Patients with left ventricular assist devices (LVADs) are at high risk for ventricular tachycardia (VT), and data on VT ablation in patients with LVAD are scarce. This multicentre registry assessed the mechanism of VT, procedural parameters, and outcome of VT ablation in patients with LVAD (NCT06063811).
Data of patients with LVAD referred for VT ablation at nine tertiary care centres were collected retrospectively. Parameters included VT mechanisms, procedural data, VT recurrence, and mortality. Overall, 69 patients (90% male, mean age 60.7 ± 8.4 years) undergoing 72 ablation procedures were included. Most procedures were conducted after intensification of antiarrhythmic drug (AAD) treatment (18/72; 25%) or a prior combination of ≥2 AADs (31/72; 43%). Endocardial low-voltage areas were detected in all patients. The predominant VT mechanism was scar-related re-entry (76/96 VTs; 79%), and 19/96 VTs (20%) were related to the LVAD cannula. Non-inducibility of any VT was achieved in 28/72 procedures (39%). No LVAD-related complication was observed. The extent of endocardial scar was associated with VT recurrence. The median follow-up was 283 days (interquartile range 70-587 days). A total of 3/69 patients were lost to follow-up, 10/69 (14%) were transplanted, 26/69 (38%) died, and 16/69 (23%) patients were free from VT.
Although often a last resort, VT ablation in patients with LVAD is feasible and safe when performed in experienced centres. These patients suffer from a high scar burden, and cardiomyopathy-associated rather than cannula-related scar seems to be the dominant substrate. Ventricular tachycardia recurrence is high despite extensive treatment, and the overall prognosis is limited.
植入左心室辅助装置（LVAD）的患者发生室性心动过速（VT）的风险很高，而关于LVAD患者VT消融的数据很少。这项多中心注册研究评估了LVAD患者VT的机制、手术参数和VT消融的结果（NCT06063811）。
回顾性收集了在9个三级医疗中心接受VT消融的LVAD患者的数据。参数包括VT机制、手术数据、VT复发和死亡率。总体而言，纳入了69例接受72次消融手术的患者（90%为男性，平均年龄60.7±8.4岁）。大多数手术是在抗心律失常药物（AAD）治疗强化后进行的（18/72；25%）或先前联合使用≥2种AAD（31/72；43%）。所有患者均检测到心内膜低电压区。主要的VT机制是瘢痕相关折返（76/96次VT；79%），19/96次VT（20%）与LVAD插管有关。28/72次手术（39%）实现了任何VT均不能诱发。未观察到与LVAD相关的并发症。心内膜瘢痕范围与VT复发有关。中位随访时间为283天（四分位间距70 - 587天）。共有3/69例患者失访，10/69（14%）接受了移植，26/69（38%）死亡，16/69（23%）患者无VT发作。
尽管VT消融通常是最后的手段，但在经验丰富的中心对LVAD患者进行VT消融是可行且安全的。这些患者瘢痕负担重，与心肌病相关而非插管相关的瘢痕似乎是主要基质。尽管进行了广泛治疗，VT复发率仍很高，总体预后有限。
