Background and objective Ventricular arrhythmias (VAs) remain a pervasive and deadly arrhythmia in patients with left ventricular assist devices (LVADs). Catheter ablation has emerged as a treatment option for refractory VAs, yet evidence in the era of the HeartMate 3 (HM3) remains limited. This review aims to synthesize contemporary evidence for VA ablation in LVAD recipients. Methods A systematic review was performed across major electronic databases. The primary efficacy outcome was the recurrence of ventricular tachycardia (VT), and the primary safety outcome was the rate of procedural complications. The secondary outcomes were inability to induce any VT, all-cause mortality at twelve months, orthotropic heart transplantation (OHT). Sub-analyses were performed for patients with HM3 LVADs. Results Twenty-seven studies encompassing 300 LVAD recipients undergoing 325 VT ablations, after a mean follow-up of 327±175 days post VT ablation, VT recurred in 38% (95% CI, 28% to 49%) of cases and the complication rate was 8% (95% CI, 1.6% to 15.7%). VT was non-inducible in 61% of cases. One-year all-cause mortality was 26%, and 16% had OHT. Among HM3 recipients, electromagnetic interference (EMI) occurred in 51%, and no cases of device thrombosis were reported; one stroke was observed. Conclusions Catheter ablation is a safe and feasible treatment for refractory VAs in LVAD patients as evidenced by low complication rates and reasonable acute success. Yet, the persistence of considerable VT recurrence and all-cause mortality reflects the clinical complexity of this population. Procedural challenges include mapping limitations caused by EMI, particularly in the HM3 era.

Background Emerging evidence suggests that a combined approach with left atrial appendage occlusion (LAAO) and catheter ablation (CA) may be a safe, effective alternative for patients with atrial fibrillation (AF) at high risk of bleeding and stroke. Objective This review seeks to systematically evaluate the safety and efficacy of this combined approach, addressing gaps in the current evidence. Methods A systematic search of PubMed, Science Direct, and Cochrane Central Register of Clinical Trials (CENTRAL) was performed for studies that reported outcomes comparing CA and LAAO vs. CA without LAAO. The Review Manager 5.4 software was utilized to conduct a meta-analysis of the outcomes. Results Six studies of 3,770 patients with AF, of whom 1778 underwent LAAO after CA vs. 1992 CA, were analyzed. After a mean follow-up of 30 months, the combined approach was associated with a significantly lower risk of major bleeding compared to CA alone (OR 0.45; 95% CI 0.26-0.78; p <0.0001). There were no differences in stroke or systemic embolism rates between groups (OR 1.00; 95% CI 0.66–1.52; p = 0.91), and no significant difference was observed in all-cause mortality (OR 0.77; 95% CI 0.34–1.74; p = 0.35). Conclusion This meta-analysis suggests that a combined approach is associated with a reduction in major bleeding while demonstrating non-inferiority in thromboembolic events and mortality compared to CA alone. Further randomized clinical trials are needed to confirm these findings.

Background and Aims Atrial fibrillation is the most prevalent cardiac arrhythmia, and catheter ablation (CA) has emerged as a viable option for selected patients. However, its role in specific liver cirrhosis (LC) populations remains underexplored. Methods Using the National Inpatient Sample Database 2016–2020, we analyzed adult encounters undergoing CA for atrial fibrillation diagnosed with LC. Using propensity scores, encounters were divided into 2 cohorts based on the presence and absence of LC and matched in a 1:1 fashion using LC as the dependent variable. In-hospital mortality and post-procedure total complications were compared using logistic regression models and linear regression for length of stay and total cost of hospitalization. Results We identified 93,830 atrial fibrillation CA admissions, of which 910 had LC. The mean age in the LC cohort was 66.5±5.1 years. Mortality did not significantly differ between the groups (aOR=0.85; 95%CI=0.28-2.60; P=0.77). However, the LC cohort exhibited higher odds of total complications (aOR=2.00; 95%CI=1.11-3.48; p<0.01). Length of stay was comparable, but total cost showed statistically significant differences among the two cohorts: 6.7 days (95%CI=6.8-7.46; P<0.0001) vs. 6.3 days (95%CI=5.4-7.2;p<0.0001) and $184,000 (95%CI=$169 000-$201 000; P<0.0001) vs. $193,000 (95%CI=$171 000-$216 000;p<0.0001), respectively. Conclusion In the 2016-2020 National Inpatient Sample, patients who underwent atrial fibrillation CA with LC, mortality, and length of stay were comparable. However, the likelihood of total complications was higher to a propensity score‐matched cohort of no cirrhotics patients. Further, longitudinal studies are needed it to assess the safety profile of CA in this sub-population