Epicardial Catheter Ablation Through Subxiphoid Surgical Approach in a Patient With Implanted Left Ventricular Assist Device and Cannula-Related Ventricular Tachycardia

摘要: A 70-year-old man with nonischemic dilated cardiomyopathy initially diagnosed in 2001 and history of cardiac resynchronization therapy-defibrillator implant was admitted to our institution for advanced heart failure therapies. He required hospitalization December 2013 marked volume overload, at which time imaging showed his left ventricular (LV) ejection fraction be 10% 15% LV end-diastolic dimension 7.9 cm. The patient underwent a Heartmate II assist device (LVAD; Thoratec, Pleasanton, CA) concurrent mitral valve ring repair, tricuspid aortic repair. However, on postoperative day 9, he developed repetitive monomorphic tachycardia (VT) rate 141 bpm (Figure 1). During VT, decrease pulsatility index noted LVAD interrogation. transesophageal echocardiogram demonstrated excellent cannula position, no evidence LVAD-cannula–induced suction events observed. VT unresponsive antitachycardia pacing, despite treatment amiodarone, lidocaine, esmolol infusions, remained incessant. Figure 1. ECG tachycardia, consistent apical site origin. An initial catheter ablation performed using an endocardial approach. 3-dimensional electroanatomic map (CARTO; Biosense Webster, Diamond Bar, the right ventricles 3.5-mm open-irrigated (Thermocool SF; Webster) small area …