Effectiveness of a percutaneous left ventricular assist device in preventing acute hemodynamic decompensation during catheter ablation of ventricular tachycardia in advanced heart failure patients: A retrospective single‐center analysis

Neuzner, Jörg; Dietze, Thomas; Paliege, R; Gradaus, Rainer

doi:10.1111/jce.14199

Cited by 9 publications

(6 citation statements)

References 36 publications

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“…In CS due to recurrent and refractory VT or ES, MCS allows vital parameter stabilization and HF status optimization before catheter ablation, that would otherwise be pointless in a patient with untreated MOF. In patients presenting for VT ablation procedures, factors contributing to AHD include the severity of heart failure and reduced left ventricular ejection fraction, underlying comorbidities, anesthesia, and the complexity of the VT substrate [ 9 , 10 ]. Patients undergoing VT ablation usually have HFrEF with severe left ventricular systolic dysfunction and lower basal CO.…”

Section: Rationale For Mechanical Circulatory Support In Patients Wit...mentioning

confidence: 99%

“…Studies comparing the efficacy of these device are scarce, and the choice of the system depends on the treating physician’s experience, device availability, patient features, and degree of circulatory support needed. Every device has pros and limitations that should guide treatment decisions ( Table 1 ) [ 8 , 10 , 11 ].…”

Section: Devices For Mechanical Circulatory Supportmentioning

confidence: 99%

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Mechanical Circulatory Support Systems in the Management of Ventricular Arrhythmias: A Contemporary Overview

Mariani,

Pierucci,

Cipollone

et al. 2024

JCM

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Ventricular tachycardias (VTs) and electrical storms (ES) are life-threatening conditions mostly seen in the setting of structural heart disease (SHD). Traditional management strategies, predominantly centered around pharmacological interventions with antiarrhythmic drugs, have demonstrated limited efficacy in these cases, whereas catheter ablation is related with more favorable outcomes. However, patients with hemodynamically unstable, recurrent VT or ES may present cardiogenic shock (CS) that precludes the procedure, and catheter ablation in patients with SHD portends a multifactorial intrinsic risk of acute hemodynamic decompensation (AHD), that is associated with increased mortality. In this setting, the use of mechanical circulatory support (MCS) systems allow the maintenance of end-organ perfusion and cardiac output, improving coronary flow and myocardial mechanics, and minimizing the effect of cardiac stunning after multiple VT inductions or cardioversion. Although ablation success and VT recurrence are not influenced by hemodynamic support devices, MCS promotes diuresis and reduces the incidence of post-procedural kidney injury. In addition, MCS has a role in post-procedural mortality reduction at long-term follow-up. The current review aims to provide a deep overview of the rationale and modality of MCS in patients with refractory arrhythmias and/or undergoing VT catheter ablation, underlining the importance of patient selection and timing for MCS and summarizing reported clinical experiences in this field.

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Section: Rationale For Mechanical Circulatory Support In Patients Wit...mentioning

confidence: 99%

Section: Devices For Mechanical Circulatory Supportmentioning

confidence: 99%

Mechanical Circulatory Support Systems in the Management of Ventricular Arrhythmias: A Contemporary Overview

Mariani,

Pierucci,

Cipollone

et al. 2024

JCM

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“…Impella-facilitated VT ablation has recently become an experimental option aiming to maintain stable hemodynamics during intraprocedurally induced VT 53,60 (Table 4). In the prospective, nonrandomized PERMIT (Percutaneous Hemodynamic Support With Impella 2.5 During Scar-related Ventricular Tachycardia Ablation) 1 trial (n=20), Impella 2.5 support during VT ablation led to significantly improved cerebral oxygenation, but the complete successful VT ablation rate was only 50%.…”

Section: Impella-facilitated Ablation Of Vtmentioning

confidence: 99%

“…Acute renal failure and pericardial effusion were reported in patients with Impella support during VT ablation, whereas the reported incidence of cardiac tamponade ranged up to 11%, occurring mostly in patients undergoing epicardial mapping and catheter ablation. 53,[58][59][60] Complications associated with Impella RP support have been rarely described in the literature so far. The most common complications are access site bleeding and hemolysis.…”

Section: Complications Associated With Impella Supportmentioning

confidence: 99%

Percutaneous Transvalvular Microaxial Flow Pump Support in Cardiology

Lüsebrink¹,

Kellnar²,

Krieg³

et al. 2022

Circulation

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The Impella device (Impella, Abiomed, Danvers, MA) is a percutaneous transvalvular microaxial flow pump that is currently used for (1) cardiogenic shock, (2) left ventricular unloading (combination of venoarterial extracorporeal membrane oxygenation and Impella concept), (3) high-risk percutaneous coronary interventions, (4) ablation of ventricular tachycardia, and (5) treatment of right ventricular failure. Impella-assisted forward blood flow increased mean arterial pressure and cardiac output, peripheral tissue perfusion, and coronary blood flow in observational studies and some randomized trials. However, because of the need for large-bore femoral access (14 F for the commonly used Impella CP device) and anticoagulation, the incidences of bleeding and ischemic complications are as much as 44% and 18%, respectively. Hemolysis is reported in as many as 32% of patients and stroke in as many as 13%. Despite the rapidly growing use of the Impella device, there are still insufficient data on its effect on outcome and complications on the basis of large, adequately powered randomized controlled trials. The only 2 small and also underpowered randomized controlled trials in cardiogenic shock comparing Impella versus intra-aortic balloon pump did not show improved mortality. Several larger randomized controlled trials are currently recruiting patients or are in preparation in cardiogenic shock (DanGer Shock [Danish-German Cardiogenic Shock Trial; NCT01633502]), left ventricular unloading (DTU-STEMI [Door-To-Unload in ST-Segment–Elevation Myocardial Infarction; NCT03947619], UNLOAD ECMO [Left Ventricular Unloading to Improve Outcome in Cardiogenic Shock Patients on VA-ECMO], and REVERSE [A Prospective Randomised Trial of Early LV Venting Using Impella CP for Recovery in Patients With Cardiogenic Shock Managed With VA ECMO; NCT03431467]) and high-risk percutaneous coronary intervention (PROTECT IV [Impella-Supported PCI in High-Risk Patients With Complex Coronary Artery Disease and Reduced Left Ventricular Function; NCT04763200]).

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“…Other groups used the PAINESD score for this purpose with variable success. 11 , 12 There are no data on the role of PAINESD in predicting haemodynamic deterioration during predominant substrate-based ablation without general anaesthesia (GA) and multiple inductions of VT. Therefore, the goal of this study was to investigate the incidence of AHD and the predictive power of the PAINESD score in a cohort of patients with ablation of SHD-related VT, based primarily on substrate mapping and pace mapping in sinus rhythm or right ventricular pacing.…”

Section: Introductionmentioning

confidence: 99%

Periprocedural acute haemodynamic decompensation during substrate-based ablation of scar-related ventricular tachycardia: a rare and unpredictable event

Stojadinović,

Wichterle,

Peichl

et al. 2024

Europace

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Aims Patients with structural heart disease (SHD) undergoing catheter ablation (CA) for ventricular tachycardia (VT) are at considerable risk of periprocedural complications, including acute haemodynamic decompensation (AHD). The PAINESD score was proposed to predict the risk of AHD. The goal of this study was to validate the PAINESD score using the retrospective analysis of data from a large-volume heart centre. Methods and results Patients who had their first radiofrequency CA for SHD-related VT between August 2006 and December 2020 were included in the study. Procedures were mainly performed under conscious sedation. Substrate mapping/ablation was performed primarily during spontaneous rhythm or right ventricular pacing. A purposely established institutional registry for complications of invasive procedures was used to collect all periprocedural complications that were subsequently adjudicated using the source medical records. Acute haemodynamic decompensation triggered by CA procedure was defined as intraprocedural or early post-procedural (<12 h) development of acute pulmonary oedema or refractory hypotension requiring urgent intervention. The study cohort consisted of 1124 patients (age, 63 ± 13 years; males, 87%; ischaemic cardiomyopathy, 67%; electrical storm, 25%; New York Heart Association Class, 2.0 ± 1.0; left ventricular ejection fraction, 34 ± 12%; diabetes mellitus, 31%; chronic obstructive pulmonary disease, 12%). Their PAINESD score was 11.4 ± 6.6 (median, 12; interquartile range, 6–17). Acute haemodynamic decompensation complicated the CA procedure in 13/1124 = 1.2% patients and was not predicted by PAINESD score with AHD rates of 0.3, 1.8, and 1.1% in subgroups by previously published PAINESD terciles (<9, 9–14, and >14). However, the PAINESD score strongly predicted mortality during the follow-up. Conclusion Primarily substrate-based CA of SHD-related VT performed under conscious sedation is associated with a substantially lower rate of AHD than previously reported. The PAINESD score did not predict these events. The application of the PAINESD score to the selection of patients for pre-emptive mechanical circulatory support should be reconsidered.

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Effectiveness of a percutaneous left ventricular assist device in preventing acute hemodynamic decompensation during catheter ablation of ventricular tachycardia in advanced heart failure patients: A retrospective single‐center analysis

Cited by 9 publications

References 36 publications

Mechanical Circulatory Support Systems in the Management of Ventricular Arrhythmias: A Contemporary Overview

Mechanical Circulatory Support Systems in the Management of Ventricular Arrhythmias: A Contemporary Overview

Percutaneous Transvalvular Microaxial Flow Pump Support in Cardiology

Periprocedural acute haemodynamic decompensation during substrate-based ablation of scar-related ventricular tachycardia: a rare and unpredictable event

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