Arash Aryana1, P Gearoid O'Neill2, David Gregory3, Dennis Scotti4, Sean Bailey5, Scott Brunton5, Michael Chang2, André d'Avila6. 1. Regional Cardiology Associates, Sacramento, California; Mercy Heart & Vascular Institute, Sacramento, California. Electronic address: aaryana@rcamd.com. 2. Regional Cardiology Associates, Sacramento, California; Mercy Heart & Vascular Institute, Sacramento, California. 3. Presscott Associates, a division of ParenteBeard, New York, New York. 4. Presscott Associates, a division of ParenteBeard, New York, New York; Fairleigh Dickinson University, Teaneck, New Jersey. 5. Mercy Heart & Vascular Institute, Sacramento, California. 6. Helmsley Cardiac Arrhythmia Service, Mount Sinai School of Medicine, New York, New York.
Abstract
BACKGROUND: Hemodynamic support using percutaneous left ventricular assist devices (pLVADs) during catheter mapping and ablation of unstable ventricular tachycardia (VT) can provide effective end-organ perfusion. However, its effect on procedural and clinical outcomes remains unclear. OBJECTIVE: To retrospectively evaluate the procedural and clinical outcomes after the catheter ablation of unstable VT with and without pLVAD support. METHODS: Sixty-eight consecutive unstable, scar-mediated endocardial and/or epicardial VT ablation procedures performed in 63 patients were evaluated. During VT mapping and ablation, hemodynamic support was provided by intravenous inotropes with a pLVAD (n = 34) or without a pLVAD (control; n = 34). RESULTS: Baseline patient characteristics were similar. VT was sustained longer with a pLVAD (27.4 ± 18.7 minutes) than without a pLVAD (5.3 ± 3.6 minutes) (P < .001). A higher number of VTs were terminated during ablation with a pLVAD (1.2 ± 0.9 per procedure) than without a pLVAD (0.4 ± 0.6 per procedure) (P < .001). Total radiofrequency ablation time was shorter with a pLVAD (53 ± 30 minutes) than without a pLVAD (68 ± 33 minutes) (P = .022), but with similar procedural success rates (71% for both pLVAD and control groups; P = 1.000). Although during 19 ± 12 months of follow-up VT recurrence did not differ between pLVAD (26%) and control (41%) groups (P = .305), the composite end point of 30-day rehospitalization, redo-VT ablation, recurrent implantable cardioverter-defibrillator therapies, and 3-month mortality was lower with a pLVAD (12%) than without a pLVAD (35%) (P = .043). CONCLUSION: In this nonrandomized retrospective study, catheter ablation of unstable VT supported by a pLVAD was associated with shorter ablation times and reduced hospital length of stay. While pLVAD support did not affect VT recurrence, it was associated with a lower composite end point of 30-day rehospitalization, redo-VT ablation, recurrent implantable cardioverter-defibrillator therapies, and 3-month mortality.
BACKGROUND: Hemodynamic support using percutaneous left ventricular assist devices (pLVADs) during catheter mapping and ablation of unstable ventricular tachycardia (VT) can provide effective end-organ perfusion. However, its effect on procedural and clinical outcomes remains unclear. OBJECTIVE: To retrospectively evaluate the procedural and clinical outcomes after the catheter ablation of unstable VT with and without pLVAD support. METHODS: Sixty-eight consecutive unstable, scar-mediated endocardial and/or epicardial VT ablation procedures performed in 63 patients were evaluated. During VT mapping and ablation, hemodynamic support was provided by intravenous inotropes with a pLVAD (n = 34) or without a pLVAD (control; n = 34). RESULTS: Baseline patient characteristics were similar. VT was sustained longer with a pLVAD (27.4 ± 18.7 minutes) than without a pLVAD (5.3 ± 3.6 minutes) (P < .001). A higher number of VTs were terminated during ablation with a pLVAD (1.2 ± 0.9 per procedure) than without a pLVAD (0.4 ± 0.6 per procedure) (P < .001). Total radiofrequency ablation time was shorter with a pLVAD (53 ± 30 minutes) than without a pLVAD (68 ± 33 minutes) (P = .022), but with similar procedural success rates (71% for both pLVAD and control groups; P = 1.000). Although during 19 ± 12 months of follow-up VT recurrence did not differ between pLVAD (26%) and control (41%) groups (P = .305), the composite end point of 30-day rehospitalization, redo-VT ablation, recurrent implantable cardioverter-defibrillator therapies, and 3-month mortality was lower with a pLVAD (12%) than without a pLVAD (35%) (P = .043). CONCLUSION: In this nonrandomized retrospective study, catheter ablation of unstable VT supported by a pLVAD was associated with shorter ablation times and reduced hospital length of stay. While pLVAD support did not affect VT recurrence, it was associated with a lower composite end point of 30-day rehospitalization, redo-VT ablation, recurrent implantable cardioverter-defibrillator therapies, and 3-month mortality.
Authors: Aditya Bharadwaj; Melissa D McCabe; Tahmeed Contractor; Hyungjin Ben Kim; Antoine Sakr; Anthony Hilliard; Ravi Mandapati; Rahul Bhardwaj Journal: JACC Case Rep Date: 2022-06-01
Authors: Mouhannad M Sadek; Robert D Schaller; Gregory E Supple; David S Frankel; Michael P Riley; Mathew D Hutchinson; Fermin C Garcia; David Lin; Sanjay Dixit; Erica S Zado; David J Callans; Francis E Marchlinski Journal: Arrhythm Electrophysiol Rev Date: 2014-11-29