Cardiopulmonary Support During Catheter Ablation of Ventricular Arrhythmias: Long-Term Results from a Single-Center Experience

Extracorporeal membranes oxygenation (ECMO) has been proposed as a useful tool to support ablation of unstable ventricular arrhythmias (VAs). The aim of this study is to assess the clinical outcome of cardiopulmonary support of VAs catheter ablation during a long-term follow-up. In this retrospective observational study, we included 47 patients referred to our center for catheter ablation of repeated episodes of hemodynamically unstable sustained VAs between April 2016 and February 2025. All patients underwent catheter ablation, supported by ECMO, of ventricular arrhythmias symptomatic for syncope or presyncope. The primary endpoint is overall cardiovascular death, including death due to heart failure, cardiogenic shock or ventricular arrhythmias. In particular, arrhythmic death was defined as death occurring during an electrical storm. After a median follow-up of 28 (7–63.5) months, cardiovascular death occurred in 26 patients (55.3%) but arrhythmic death befell only 11 patients (23.4%). All deaths occurred within 6–7 years of follow-up. No difference exists between ischemic and non-ischemic cardiomyopathy with regard to primary endpoints. Moreover, arrhythmic recurrences occurred in 21 patients (44.7%), among whom only 15 (31.9%) had ICD shocks; 25 patients (55.3%) encountered further hospitalizations. ECMO may facilitate procedural mapping and acute ablation success in selected high-risk patients, while long-term prognosis remains mainly driven by advanced heart failure.