Abstract

HeartMate 3 (HM3) is a fully magnetically levitated continuous flow left ventricular assist device (LVAD). In patients with HM3 and recurrent ventricular tachycardia (VT), data on the outcomes of catheter ablation (CA) are insufficient. We report our institutional experience with CA of VT in patients with the HM3.Consecutive patients with HM3 and recurrent drug-refractory VT undergoing CA were included. Ablation sites were identified using activation/entrainment mapping (stable VTs) and/or late/fractionated potential ablation and pace-mapping (unstable VTs). Between 2016-2023 a total of 431 patients (age 58±13, INTERMACS 3±0.98, 44% ischemic cardiomyopathy) received an HM3 LVAD at our institution. Of these, 15 (3.4%) underwent CA for recurrent VT despite therapy with 1.3±0.8 antiarrhythmic drugs a median of 700 days from the LVAD surgery (2 patients <1 month from the surgery). The LV access was transseptal in 12 (80%) cases, retrograde aortic in 2 (13%) and both in 1 (7%). A total of 23 distinct VTs were targeted. Of these, 21 (91%) were mapped with activation/entrainment mapping, always utilizing an intracardiac RV reference due to excessive surface ECG noise, and 2 (9%) were hemodynamically unstable with reduced LVAD flows and targeted with substrate-based ablation. A total of 3 (13%) VTs were targeted adjacent to the HM3 inflow cannula, and 20 (87%) from substrate remote from the HM3 cannula. At post-procedural programmed ventricular stimulation, non-inducibility of all targeted VTs was achieved in 13 (87%) patients, 1 patient had residual inducible clinical VT, and in 1 patient no post-procedural programmed stimulation was performed. Periprocedural complications occurred in 1 (7%) case (small pericardial effusion not requiring intervention). At 12 months follow-up following the index procedure, no death occurred and one patient received heart transplantation. Of the remaining 14 patients, 6 (42%) remained free from VT (2 with VT ablation <1 month post-LVAD and 12 with VT ablation >=1 month post-LVAD). In this large single-center HM3 registry, a minority of patients underwent CA for recurrent drug-refractory VT (3.4% over a 7-year period). CA of VT in HM3 recipients is feasible and appears safe also when performed soon after LVAD surgery. Myocardial scar from the underlying cardiomyopathic process rather than the apical cannula is the dominant substrate responsible for VT in these patients.