Silvia Mariani1, L Christian Napp2, Valeria Lo Coco3, Thijs S R Delnoij4, Justin G L M Luermans5, Rachel M A Ter Bekke5, Carl Timmermans5, Tong Li6, Guenes Dogan6, Jan D Schmitto6, Jos Maessen7, Bart Maesen3, Roberto Lorusso7. 1. Department of Cardiothoracic, Transplantation and Vascular, Surgery, Hannover Medical School, Hannover, Germany. Electronic address: Mariani.Silvia@mh-hannover.de. 2. Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany. 3. Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands. 4. Cardiology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands. 5. Cardiology Department, Maastricht University Medical Centre, Maastricht, The Netherlands. 6. Department of Cardiothoracic, Transplantation and Vascular, Surgery, Hannover Medical School, Hannover, Germany. 7. Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
Abstract
BACKGROUND: The use of temporary mechanical circulatory support (tMCS) during arrhythmia is increasing, although available evidence for this indication is limited, with significant gaps of knowledge regarding appropriate timing, management and configuration. This systematic review sought to analyze the use of tMCS in patients with life-threatening arrhythmia. METHODS: A systematic literature search identified 2529 references published until September 2019. Adult and pediatric patients diagnosed with all kind of life-threatening arrhythmia were included. tMCS was primarily compared to conventional non-tMCS therapies. Primary outcome measure was in-hospital or 30-day mortality. RESULTS: 19 non-randomized studies were selected, including 2465 adult and 82 pediatric patients. Primary outcome in tMCS patients varied widely (4-62%) with differences based on the use of prophylactic tMCS (4-21%) or rescue tMCS (58-62%). A substantial mortality benefit was observed among high-risk patients, as identified with PAINESD risk score or suffering from electrical storm and treated with prophylactic tMCS. During ablation procedures, tMCS patients showed higher rates of induced ventricular tachycardias (VTs), ablated VTs, VT termination and non-inducibility after ablation. Extracorporeal membrane oxygenation (ECMO) was applied in pediatric cases as hemodynamic protection for aggressive antiarrhythmic medical treatment with >80% survival. CONCLUSIONS: Prophylactic tMCS is associated with improved survival as compared to rescue or no-tMCS in patients with life-threatening arrhythmia, and may be considered in patients with high PAINESD risk score or suffering from electrical storm. ECMO can be advised as rescue and support therapy in pediatric cases requiring aggressive antiarrhythmic medical treatment.
BACKGROUND: The use of temporary mechanical circulatory support (tMCS) during arrhythmia is increasing, although available evidence for this indication is limited, with significant gaps of knowledge regarding appropriate timing, management and configuration. This systematic review sought to analyze the use of tMCS in patients with life-threatening arrhythmia. METHODS: A systematic literature search identified 2529 references published until September 2019. Adult and pediatric patients diagnosed with all kind of life-threatening arrhythmia were included. tMCS was primarily compared to conventional non-tMCS therapies. Primary outcome measure was in-hospital or 30-day mortality. RESULTS: 19 non-randomized studies were selected, including 2465 adult and 82 pediatric patients. Primary outcome in tMCSpatients varied widely (4-62%) with differences based on the use of prophylactic tMCS (4-21%) or rescue tMCS (58-62%). A substantial mortality benefit was observed among high-risk patients, as identified with PAINESD risk score or suffering from electrical storm and treated with prophylactic tMCS. During ablation procedures, tMCSpatients showed higher rates of induced ventricular tachycardias (VTs), ablated VTs, VT termination and non-inducibility after ablation. Extracorporeal membrane oxygenation (ECMO) was applied in pediatric cases as hemodynamic protection for aggressive antiarrhythmic medical treatment with >80% survival. CONCLUSIONS: Prophylactic tMCS is associated with improved survival as compared to rescue or no-tMCS in patients with life-threatening arrhythmia, and may be considered in patients with high PAINESD risk score or suffering from electrical storm. ECMO can be advised as rescue and support therapy in pediatric cases requiring aggressive antiarrhythmic medical treatment.
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