Combined TAVR and Ventricular Tachycardia Ablation for VT Storm With Severe Aortic Stenosis.

OBJECTIVE

To describe the feasibility and clinical considerations of a simultaneous transcatheter aortic valve replacement (TAVR) and ventricular tachycardia (VT) ablation in a critically ill patient with severe aortic stenosis and VT storm.

KEY STEPS

Preprocedural planning involved both electrophysiology and structural teams present. Transfemoral TAVR was performed using a Sapien S3 valve (Edwards Lifesciences) under general anesthesia with both transesophageal and transthoracic echocardiography guidance. While crossing the aortic valve into the left ventricle, VT occurred and was promptly cardioverted.We then transitioned to ablation of VTs, targeting their origin in the left ventricular scar. After the procedure, we monitored for recurrence of VT and potential device upgrade for heart block. Potential Pitfalls: Issues that can arise include hemodynamic instability during valve crossing and rapid pacing, risk of complete heart block, reinducibility of VT after valve implantation, and prolonged procedure time, which requires careful anesthetic and electrophysiologic planning.

TAKE-HOME MESSAGES: Combined TAVR and VT ablation is feasible and can effectively treat 2 life-threatening problems in high-risk patients. A team-based, individualized approach is essential for procedural success.