Fernández-Caso Melanie, Carta-Bergaz Alejandro, Castrodeza Javier, Sousa-Casasnovas Iago, Ortiz-Bautista Carlos, Pedraz-Prieto Álvaro, Barrio-Gutiérrez José María, Bermejo Javier
Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain.
Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Calle Doctor Esquerdo 46, 28007 Madrid, Spain.
Eur Heart J Case Rep. 2025 Aug 31;9(9):ytaf378. doi: 10.1093/ehjcr/ytaf378. eCollection 2025 Sep.
Ventricular tachycardias (VTs) are a life-threatening complication of patients with end-stage left ventricular dysfunction, and are a frequent cause for considering advanced therapies. Their management in patients supported by a left ventricular assist device (LVAD) presents unique challenges, requiring a multidisciplinary approach to tailored strategies.
We present the case of a 70-year-old male with a history of VTs who underwent HeartMate 3 (Abbott, USA) implantation for advanced heart failure secondary to ischaemic cardiomyopathy and refractory VTs. Following LVAD implantation, he developed an electrical storm refractory to a combination of antiarrhythmic drugs and both radiofrequency and pulse-field catheter ablations. Due to persistent VT, neuromodulation of the sympathetic nervous system was considered as a last-resort strategy. Percutaneous radiofrequency ablation of the stellate ganglion was unsuccessful; however, left surgical sympathectomy effectively controlled the arrhythmias. The patient has remained free of arrhythmic events at 1-year follow-up.
Management of VTs in LVAD carriers is typically stepwise, beginning with correction of reversible triggers and the use of antiarrhythmic drugs. However, monotherapy is often insufficient, and achieving arrhythmic control often depends on a multimodal approach. In cases refractory to conventional measures, escalation to catheter ablation, neuromodulation techniques, and stereotactic arrhythmia radioablation may prove effective.
室性心动过速（VTs）是终末期左心室功能障碍患者的一种危及生命的并发症，也是考虑采用高级治疗方法的常见原因。在接受左心室辅助装置（LVAD）支持的患者中，对其进行管理面临独特挑战，需要采取多学科方法制定个性化策略。
我们报告一例70岁男性患者，有室性心动过速病史，因缺血性心肌病继发晚期心力衰竭和难治性室性心动过速接受了HeartMate 3（美国雅培公司）植入术。LVAD植入后，他出现了电风暴，对抗心律失常药物以及射频和脉冲场导管消融联合治疗均无效。由于室性心动过速持续存在，交感神经系统的神经调节被视为一种最后手段的策略。经皮射频消融星状神经节未成功；然而，左胸交感神经切除术有效控制了心律失常。在1年的随访中，患者未再发生心律失常事件。
LVAD植入者室性心动过速的管理通常是逐步进行的，首先纠正可逆性触发因素并使用抗心律失常药物。然而，单一疗法往往不足，实现心律失常控制通常取决于多模式方法。在对常规措施难治的病例中，升级到导管消融、神经调节技术和立体定向心律失常射频消融可能有效。
