Hybrid Catheter Ablation and minimally Invasive LVAD Implantation in a high-risk patient with Refractory Ventricular Tachycardia

Background There remains ongoing controversy regarding the suitability of left ventricular assist device (LVAD) implantation in patients with end-stage heart failure who present with preoperative frequent ventricular arrhythmias. How to implement effective strategies to reduce the occurrence of postoperative ventricular arrhythmias following LVAD implantation has become a key focus of clinical attention. Case presentation A 59-year-old woman with hypertrophic cardiomyopathy and end-stage heart failure presented with recurrent Ventricular Tachycardia (VT) resistant to pharmacotherapy and electrical cardioversion. Contraindications to transplantation included hemodynamic instability and panel-reactive antibody sensitization. We adopted 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. Postoperatively, transient VT recurrence on day 4 resolved with amiodarone. The patient achieved stable hemodynamics, was extubated by day 2, and discharged on day 21. At 15-months follow-up, she maintained improved quality of life with no sustained VT episodes and stable cardiac function Conclusions This case demonstrates the feasibility of the hybrid minimally invasive strategy as a destination or bridge therapy for high-risk patients with refractory arrhythmias and transplant contraindications. Further follow-up is required to evaluate long-term outcomes.