Key result
Bailout VT ablation in cardiogenic shock enables mechanical support weaning in ~81% of patients.
Why the study?
Data are limited regarding radiofrequency ablation for ventricular tachycardia in patients with cardiogenic shock and concomitant refractory ventricular tachycardia on mechanical support.
Does bailout catheter ablation allow for successful weaning from mechanical support and improve survival in patients with cardiogenic shock and refractory ventricular tachycardia?
Observational (n=21)
No
Does bailout catheter ablation allow for successful weaning from mechanical support and improve survival in patients with cardiogenic shock and refractory ventricular tachycardia?
Bailout catheter ablation for refractory ventricular arrhythmias in cardiogenic shock is feasible and facilitates weaning from mechanical support in most patients, although overall mortality remains high.
Bailout ablation may facilitate weaning from mechanical support in refractory VT with cardiogenic shock; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: There is paucity of data regarding radiofrequency ablation for ventricular tachycardia (VT) in patients with cardiogenic shock and concomitant VT refractory to antiarrhythmic drugs on mechanical support. METHODS: Patients undergoing VT ablation at our center were enrolled in a prospectively maintained registry and screened for the current study (2010-2017). RESULTS: All 21 consecutive patients with cardiogenic shock and concomitant refractory ventricular arrhythmia undergoing bailout ablation due to inability to wean off mechanical support were included. Median age was 61 years, 86% were men, median left ventricular ejection fraction was 20%, 81% had ischemic cardiomyopathy, and PAINESD score was 18±5. The type of mechanical support in place before the procedure was intra-aortic balloon pump in 14 patients (67%), Impella CP in 2, extracorporeal membrane oxygenation in 2, extracorporeal membrane oxygenation and intra-aortic balloon pump in 2, and extracorporeal membrane oxygenation and Impella CP in 1. Endocardial voltage maps showed myocardial scar in 19 patients (90%). The clinical VTs were inducible in 13 patients (62%), whereas 6 patients had premature ventricular contraction-induced ventricular fibrillation/VT (29%), and VT could not be induced in 2 patients (9%). Activation mapping was possible in all 13 with inducible clinical VTs. Substrate modification was performed in 15 patients with scar (79%). After ablation and scar modification, the arrhythmia was noninducible in 19 patients (91%). Seventeen (81%) were eventually weaned off mechanical support successfully, but 6 (29%) died during the index admission from persistent cardiogenic shock. Patients who had ventricular arrhythmia and cardiogenic shock on presentation had a trend toward lower in-hospital mortality compared with those who presented with cardiogenic shock and later developed ventricular arrhythmia. CONCLUSIONS: Bailout ablation for refractory ventricular arrhythmia in cardiogenic shock allowed successful weaning from mechanical support in a large proportion of patients. Mortality remains high, but the majority of patients were discharged home and survived beyond 1 year.
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Ballout et al. (2020) conducted an observational in Cardiogenic shock with refractory ventricular tachycardia on mechanical support (n=21). Bailout radiofrequency catheter ablation was evaluated on Successful weaning from mechanical hemodynamic support. Bailout ablation for refractory ventricular arrhythmia in cardiogenic shock resulted in successful weaning from mechanical support in 81% of patients, with 71% surviving to hospital discharge.
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