Percutaneous Left Ventricular Assist Devices in Ventricular Tachycardia Ablation

Abstract

Background Data on relative safety, efficacy, and role of different percutaneous left ventricular assist devices for hemodynamic support during the ventricular tachycardia (VT) ablation procedure are limited. Methods and Results We performed a multicenter, observational study from a prospective registry including all consecutive patients (N=66) undergoing VT ablation with a percutaneous left ventricular assist devices in 6 centers in the United States. Patients with intra-aortic balloon pump (IABP group; N=22) were compared with patients with either an Impella or a TandemHeart device (non-IABP group; N=44). There were no significant differences in the baseline characteristics between both the groups. In non-IABP group (1) more patients could undergo entrainment/activation mapping (82% versus 59%; P=0.046), (2) more number of unstable VTs could be mapped and ablated per patient (1.05±0.78 versus 0.32±0.48; P<0.001), (3) more number of VTs could be terminated by ablation (1.59±1.0 versus 0.91±0.81; P=0.007), and (4) fewer VTs were terminated with rescue shocks (1.9±2.2 versus 3.0±1.5; P=0.049) when compared with IABP group. Complications of the procedure trended to be more in the non-IABP group when compared with those in the IABP group (32% versus 14%; P=0.143). Intermediate term outcomes (mortality and VT recurrence) during 12±5-month follow-up were not different between both groups. Left ventricular ejection fraction ≤15% was a strong and independent predictor of in-hospital mortality (53% versus 4%; P<0.001). Conclusions Impella and TandemHeart use in VT ablation facilitates extensive activation mapping of several unstable VTs and requires fewer rescue shocks during the procedure when compared with using IABP.

Acute Hemodynamic Decompensation During Catheter Ablation of Scar-Related Ventricular Tachycardia

“…If confirmed in independent and larger patient cohorts, a combination of the clinical variables above might help to select patients who might benefit the most from substrate-based ablation approaches to minimize the risk of hemodynamic impairment caused by multiple VT inductions for activation and entrainment mapping 4,14 or to identify upfront patients requiring prophylactic mechanical hemodynamic support; in this regard, a careful and refined patient selection is of utmost importance to optimize the implementation and costeffectiveness of these new technologies. 15,16 The adverse effect of comorbidities, such as COPD and diabetes mellitus, in the setting of scar-related VT ablation is a novel finding and is consistent with what has been reported for other invasive cardiac procedures. [17][18][19] Among procedural variables, use of general anesthesia was found to be another predictor of AHD.…”

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

“…Takie interwencje mogą również zapewnić okno czasowe umożliwiające interwencję wieńcową we wstrząsie kardiogennym z powodu nawracającego VT lub VF. Mimo że urządzenia do wspomagania czynności komory mogą pozwolić na stabilizację stanu hemodynamicznego, to prawdopodobieństwo nawrotu VT lub VF jest duże, a leczenie interwencyjne -trudne [254].…”

Outcomes of Ventricular Tachycardia Ablation Using Percutaneous Left Ventricular Assist Devices

“…[1][2][3][4][5][6][7][8][9] To facilitate entrainment and activation mapping of hemodynamically unstable VT and mitigate the effects of frequent induction and prolonged VT duration on end-organ perfusion, several studies have demonstrated the feasibility of percutaneous left ventricular assist devices (pLVADs) for hemodynamic support during ablation procedures. [10][11][12][13][14] In these studies, pLVAD support resulted in increased mapping time during VT, less requirement for VT termination because of hemodynamic instability, and more VT terminations during ablation. However, there is limited data to ascertain whether this acute hemodynamic benefit translates into improved clinical outcomes.…”