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Address reprint requests and correspondence: Dr T. Jared Bunch, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Room 4A100, Salt Lake City, UT 84132.
In patients with significant heart failure or refractory arrhythmias, left ventricular
assist devices can be used to provide procedural stability during ventricular tachycardia
(VT) ablation. Percutaneous right ventricular assist devices (pRVADs) are also available,
but their use to assist in VT ablation has not been reported in patients with significant
right ventricular cardiomyopathies. Aguilar et al (DOI: https://doi.org/10.1016/j.hrcr.2019.10.019) shared a case of a 71-year-old man with late surgical repair of a sinus venosus
atrial septal defect and severe right ventricular dilatation with moderate systolic
dysfunction (ejection fraction of 27%) and VT storm. An initial ablation attempt was
aborted during mapping of VT that progressed to pulseless electrical activity. For
the second procedure, a TandemHeart pRVAD using the ProtekDuo dual lumen cannula (LivaNova,
London, UK) was inserted through a right internal jugular venous access, with the
inflow and outflow ports positioned in the right atrium and main pulmonary artery,
respectively. Three VTs were induced from regions around the tricuspid annulus and
were mapped and successfully ablated without disruption of pRVAD location and function.
The total time spent in VT was approximately 30 minutes. This study highlights the
use of pRVAD technology to support VT ablation in patients with significant right
ventricular cardiomyopathy and hemodynamic instability.
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