Ventricular Tachycardia Induced Cardiomyopathy and Cardiogenic Shock: Successful Berlin Heart Explantation after RVOT Ablation

Background: Dilated cardiomyopathy (DCM) is a severe condition resulting in heart failure and currently the main cause of heart transplant in children. In many cases no treatable conditions are found. Patients with an underlying infection or arrhythmia may have a higher chance of recovery if treatment is initiated early. In the most severe forms of DCM with ventricular failure, the implantation of a left ventricular assist device (LVAD) is the only option as a bridge to transplant or recovery. We report of a child with ventricular tachycardia induced tachycardiomyopathy and successful weaning after RVOT ablation while on Berlin Herat support

Methods: The 4-year-old girl presented in cardiogenic shock with severe ventricular failure and many different arrhythmias. After initial VA-ECMO therapy she underwent LVAD placement (Berlin Heart 25 mL ventricle). During the first weeks on our ICU several episodes of broad complex tachycardia was observed clearly responsive to Adenosine. Therefore, a supraventricular origin of the arrhythmias was estimated. An antiarrhythmic therapy with Amioradon, Landiolol and Sotalol was partially effective but, however, not able to completely resolve these arrythmias. Finally, there was some evidence that these arrhythmias could originate from the right ventricular outflow tract. An electrophysiological study was initiated and conducted under analgosedation and spontaneous breathing.

Results: We could identify an arrhythmogenic substrate in the RVOT, left-lateral posterior just beneath the pulmonal valve. In the fourth ablation attempt (25–30Watt, 60s), the ventricular tachycardia could be definitively terminated. There was no complications, especially no bleeding or perforation. The antiarrhythmic therapy was discontinued, and the patient was gradually weaned of the LVAD by reducing the Berlin Heart rate. Finally, the left ventricular assist device was successfully explanted one month after the ablation and the patient discharged home 2 weeks later.

Conclusion: To the best of our knowledge, we report the first successful RVOT ablation in a child on ventricular assist device. The ablation resulted in a complete recovery of the ventricular function, subsequently successful weaning off the LVAD and thus avoiding heart transplantation. Repetitive and refractory arrhythmias in severe DCM are a common secondary phenomenon but may also be the primary cause of severe heart failure; they should prompt open root-cause discussion and adequate investigation.

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Artikel online veröffentlicht:
13. Februar 2024