Does mechanical circulatory support prevent acute hemodynamic decompensation in advanced heart failure patients undergoing ventricular tachycardia ablation?
Prophylactic use of percutaneous mechanical circulatory support during ventricular tachycardia ablation in patients with severe left ventricular dysfunction is feasible and may prevent acute hemodynamic decompensation.
INTRODUCTION: Acute hemodynamic decompensation during catheter ablation of ventricular tachycardia is associated with increased mortality. We assessed the effectiveness of mechanical circulatory support using a micro-axial percutaneous assist device in preventing acute hemodynamic decompensation. METHODS AND RESULTS: Twenty-six consecutive patients with structural heart disease undergoing 28 ventricular tachycardia ablations between May 2013 and October 2017 were included. All patients presenting with left ventricular ejection fraction <25%, symptomatic heart failure and arrhythmia associated hemodynamic decompensation underwent catheter ablation with mechanical circulatory support (Impella 2.5; Impella CP, Abiomed, Danvers, MA). Electro-anatomic mapping was performed using Ensite NavX (Abbott, Chicago, IL) or Rhythmia (Boston Scientific, Marlborough, MA) mapping systems. Mapping/ablation strategy included a substrate and activation mapping/ablation. Of the 26 patients, 80% had ischemic cardiomyopathy, the mean age was 68 ± 9 years; mean left ventricular ejection fraction 19.6% ± 3%, mean PAAINESD score was 21 ± 3. Mean tachycardia cycle length was 348 ± 76 ms (range 280-500 ms). The assist device was used pre-emptively in 25 patients and as rescue therapy in one patient. All ventricular tachycardias occurring during substrate ablation were activation mapped and ablated. The ablation procedure was accomplished in 25 of 26 patients, acute decompensation occurred only in one patient receiving circulatory support as bail-out therapy. CONCLUSION: In patients with advanced heart failure and a high probability of acute hemodynamic decompensation during catheter ablation, mechanical circulatory support prevented acute decompensation in 25 of 26 patients. Thus, mechanical circulatory support facilitates catheter ablation of unstable ventricular tachycardia in a critically ill patient population.
Neuzner et al. (Tue,) studied this question.