Preemptive mechanical circulatory support in ventricular tachycardia ablation: A systematic review and meta-analysis
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Key result
Preemptive MCS during VT ablation shows no mortality benefit over ablation without support.
- OR 1.58
- 95% CI 0.60-4.19
- P=0.36
- n=2,262
Why the study?
The benefit of preemptive mechanical circulatory support for ventricular tachycardia ablation remains unclear.
Does preemptive mechanical circulatory support reduce all-cause mortality in patients undergoing ventricular tachycardia ablation?
Key Points
- To evaluate the comparative efficacy and safety of preemptive mechanical circulatory support versus standard care in patients undergoing ventricular tachycardia ablation.
- Conducted a systematic search across PubMed, Embase, and Web of Science for studies evaluating preemptive mechanical circulatory support (percutaneous left ventricular assist devices or extracorporeal membrane oxygenation) during ventricular tachycardia ablation.
- Included 8 studies totaling 2,262 patients (414 with support, 1,848 without) with a mean follow-up of 15.8 months, mean age of 62.6 years, and 12.5% women, assessing mortality, recurrence, procedure times, and complications.
- Preemptive mechanical support was not associated with a significant difference in all-cause mortality (OR 1.58, 95% CI 0.60-4.19, p = 0.36, I²=81%) or ventricular tachycardia recurrence (OR 1.03, 95% CI 0.68-1.56, p = 0.90, I²=46%).
Study Design
Type
Meta-Analysis (n=2,262)
Structured PICO
Does preemptive mechanical circulatory support reduce all-cause mortality in patients undergoing ventricular tachycardia ablation?
P
Population
2,262 patients undergoing ventricular tachycardia ablation, including 414 receiving preemptive mechanical circulatory support, with a mean age of 62.6 years and followed for a mean of 15.8 months.
I
Intervention
Preemptive mechanical circulatory support (MCS) including percutaneous left ventricular assist devices (pLVAD) or venoarterial extracorporeal membrane oxygenation (VA-ECMO) prior to or at the start of the ablation procedure.
C
Comparator
Ablation without mechanical circulatory support (standard care).
O
Outcome
All-cause mortality at follow-up interval reported by each study.hard clinical
Main Result
Odds Ratio: 1.58 (95% CI 0.6–4.19)
p-value: p=0.36
Preemptive mechanical circulatory support during VT ablation does not significantly improve all-cause mortality or VT recurrence but is associated with longer procedures and increased procedural complications.
Limitations
- All included studies were observational and nonrandomized, raising concern for selection bias and confounding by indication.
- Significant heterogeneity among the included studies.
- Inconsistent reporting of complication subtypes across the available studies.
- Small number of studies precluded formal assessment of publication bias.
- The systematic review protocol was not prospectively registered.
- Observational study design of included studies
- Baseline imbalance between groups (confounding by indication)
- Substantial heterogeneity across studies
- Available studies did not consistently report all complication subtypes
- Exclusion of intra-aortic balloon pump (IABP) as a sole source of MCS
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
PSPasquale SantangeliDirector, VT Program, Cleveland Clinic Electrophysiology
“We thought that supporting patients with a high-flow device would improve outcomes in terms of 30-day and one-year mortality, since prior reports suggested it would. Yet we found it had no significant impact. Numerically, there was a significant reduction in periprocedural acute hemodynamic decompensation events in the device arm, but this benefit was offset by a tenfold higher rate of complications with the Impella device.”
“This does not automatically imply that the use of Impella should be avoided in all patients. There almost certainly are some niche populations that will benefit. All this study shows is that... it perhaps does not warrant a broad application to all high-risk patients, and that patient selection is vital.”
“Although PMCS allows mapping during VT, it does not significantly influence acute outcomes and not convincingly long-term outcomes. On the contrary, the complication rate appears to be higher in PMCS cohorts.”
Implication
Preemptive MCS shows no mortality or recurrence benefit but increases procedural time and complications; leaves open selective use in highest-risk patients pending RCTs.
Abstract
BACKGROUND: The benefit of preemptive mechanical circulatory support (MCS) for ventricular tachycardia (VT) ablation remains unclear. This meta-analysis compared the efficacy and safety of preemptive MCS to standard care for VT ablation. METHODS: An unrestricted literature search of PubMed, Embase, and Web of Science identified studies on preemptive MCS for VT ablation. MCS included percutaneous left ventricular assist devices or extracorporeal membrane oxygenation. The primary endpoint was all-cause mortality; secondary endpoints included VT recurrence, procedural time, procedural complications (vascular access, bleeding, stroke, pericardial effusion, heart failure, myocardial infarction), and 30-day major adverse cardiovascular events (MACE). RESULTS: Eight studies with 2,262 patients (414 with MCS, 1,848 without) were included. Mean follow-up was 15.8 months, mean age was 62.6 years, 12.5% were women, and mean PAINESD scores were 15.7 in the MCS group and 10.5 in the no-MCS group. There was no significant difference in all-cause mortality (OR 1.58, 95% CI 0.60-4.19, p = 0.36, I²=81%) or VT recurrence (OR 1.03, 95% CI 0.68-1.56, p = 0.90, I²=46%). Preemptive MCS was associated with longer procedural times (mean difference 46.0 min, 95% CI 11.1-80.8, p = 0.01, I²=86%), more procedural complications-driven by vascular access and pericardial effusion (OR 2.25, 95% CI 1.26-4.03, p = 0.006, I²=33%). Thirty-day MACE was not uniformly defined across studies and was therefore not pooled. CONCLUSIONS: Preemptive MCS was not associated with a significant difference in all-cause mortality or VT recurrence in patients undergoing VT ablation but was associated with longer procedures, and more procedural complications. The certainty of evidence was very low, reflecting the observational study design, baseline imbalance between groups, and heterogeneity; these findings do not preclude the selective use of MCS in high-risk patients and require confirmation in randomized trials.
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Cite This Study
Zhang et al. (2026) conducted a meta-analysis in Ventricular tachycardia undergoing ablation (n=2,262). Preemptive mechanical circulatory support (MCS) vs. Ablation without mechanical circulatory support was evaluated on All-cause mortality (OR 1.58, 95% CI 0.60-4.19, p=0.36). Preemptive mechanical circulatory support during ventricular tachycardia ablation was not associated with a significant difference in all-cause mortality (OR 1.58) compared to ablation without support.
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