Hybrid catheter ablation and minimally invasive LVAD implantation in a high-risk patient with refractory ventricular tachycardia.

BACKGROUND

The suitability of left ventricular assist device (LVAD) implantation in patients with end-stage heart failure who present with preoperative frequent ventricular arrhythmias(VAs) remains controversial. Developing effective strategies to reduce the occurrence of postoperative VAs is a key clinical priority.

CASE PRESENTATION: A 59-year-old woman with hypertrophic cardiomyopathy and end-stage heart failure presented with recurrent Ventricular Tachycardia (VT) refractory to pharmacotherapy and electrical cardioversion. Transplantation difficulties included hemodynamic instability, panel-reactive antibody sensitization and limited donor resource. We performed a single-stage minimally invasive approach to treat the patient, including VT radiofrequency ablation, atrial septal defect (ASD) closure, and minimally invasive left lateral LVAD implantation. Transient VT recurrence on postoperative day 4 resolved with amiodarone. The patient achieved stable hemodynamics, was extubated by day 2, and discharged on day 21. At 15-month follow-up, she maintained improved quality of life without sustained VT episodes and stable cardiac function.

CONCLUSIONS

This hybrid minimally invasive strategy demonstrates the feasibility as a destination or bridge therapy for high-risk patients with refractory arrhythmias and transplant difficulties. Long-term outcomes require further evaluation.