Successful ventricular tachycardia ablation in a patient with a biventricular ventricular assist device and heparin-induced thrombocytopenia using bivalirudin

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Presentation transcript:

Successful ventricular tachycardia ablation in a patient with a biventricular ventricular assist device and heparin-induced thrombocytopenia using bivalirudin Gordon Ho, MD, Hao A. Tran, MD, Marcus A. Urey, MD, Eric D. Adler, MD, Victor G. Pretorius, MBchB, Jonathan C. Hsu, MD, MAS, FHRS HeartRhythm Case Reports Volume 4, Issue 8, Pages 367-370 (August 2018) DOI: 10.1016/j.hrcr.2018.05.005 Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 1 Ventricular tachycardia ablation for a patient with a biventricular assist device. A: An anteroposterior fluoroscopy image shows ventricular assist devices implanted at the right atrial wall (red arrow) and the left ventricular apex. An intracardiac echocardiography (ICE) catheter (white arrow) and transseptal steerable sheath are in close proximity to the right atrial inflow cannula (red arrow). The right atrial inflow cannula is visualized using ICE (C, red arrow). B: Electroanatomic mapping demonstrates extensive substrate ablation (round balls) with the left ventricular assist device inflow cannula denoted by the yellow circle and mesh (yellow arrow), visualized by ICE and CartoSound (D, yellow arrow). HeartRhythm Case Reports 2018 4, 367-370DOI: (10.1016/j.hrcr.2018.05.005) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 2 Trend of activated clotting time with bivalirudin dose during ventricular tachycardia ablation. A graph of the activated clotting time (ACT) is plotted against time during the procedure with timing and dosing of boluses (top) and infusion (bottom). The baseline ACT was 171 seconds at the beginning of the case on the patient’s maintenance bivalirudin. The patient was off continuous renal replacement therapy during the case. HeartRhythm Case Reports 2018 4, 367-370DOI: (10.1016/j.hrcr.2018.05.005) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 3 Induced ventricular tachycardia. This surface and intracardiac electrogram shows programmed electrical stimulation using double extrastimuli (400–200–240) inducing a ventricular tachycardia that spontaneously changes morphology from a right bundle branch block inferior axis to a left bundle branch block superior axis apical morphology. HeartRhythm Case Reports 2018 4, 367-370DOI: (10.1016/j.hrcr.2018.05.005) Copyright © 2018 Heart Rhythm Society Terms and Conditions