Mechanical support with PVAD during ventricular tachycardia ablation was associated with lower index mortality compared to IABP (6.5% vs. 19.1%; P=0.001).
Cohort (n=345)
Yes
Does mechanical support with a percutaneous ventricular assist device (PVAD) improve clinical outcomes compared to an intra-aortic balloon pump (IABP) in patients undergoing catheter ablation of ventricular tachycardia?
In a retrospective Medicare cohort, the use of a PVAD rather than an IABP for mechanical support during VT ablation was associated with significantly lower in-hospital mortality, cardiogenic shock, and 30-day readmissions.
Absolute Event Rate: 6.5% vs 19.1%
p-value: p=0.001
INTRODUCTION: There is a paucity of data in favor of mechanical support during catheter ablation of ventricular tachycardia (VT). This study investigated the outcomes of VT ablation associated with mechanical support using percutaneous ventricular assist device (PVAD) versus intra-aortic balloon pump (IABP). METHODS AND RESULTS: We retrospectively examined the outcomes of patients who underwent VT ablation associated with PVAD versus IABP from 2010 to 2013, captured by the Medicare Inpatient Standard Analytic File database. Data from 345 patients (PVAD = 230, IABP = 115) were examined. On admission, the incidence of heart failure was higher in PVAD (84.3% vs. 73.0%; P = 0.01) with similar rates of renal failure in PVAD versus IABP (33.0% vs. 37.4%; P = 0.42). However, PVAD was associated with reduced in-hospital cardiogenic shock (9.1% vs. 23.5%; P < 0.001), renal failure (11.7% vs. 21.7%; P = 0.01), and length of stay (8.4 ± 7.9 vs. 10.6 ± 7.5; P < 0.001), but with greater hospital discharges to home/self-care (66.0% vs. 51.6%; P = 0.02). Index mortality (6.5% vs. 19.1%; P = 0.001) and mortality in patients with cardiogenic shock (18.2% vs. 41.2%; P = 0.03) were significantly lower with PVAD versus IABP. Furthermore, PVAD was associated with lower all-cause (27.0% vs. 38.7%; P = 0.04) and heart failure-related (21.4% vs. 33.3%; P = 0.03) 30-day hospital readmissions, but with similar redo-VT ablation rates at 1 year (10.2% vs. 14.0%; P = 0.34). CONCLUSION: Among the cases captured by the Medicare database, catheter ablation of VT associated with mechanical support using PVAD was associated with reduced in-hospital cardiogenic shock, renal failure, length of stay, hospital readmissions and mortality, but no difference in redo-VT ablation at 1 year.
Aryana et al. (Fri,) conducted a cohort in Ventricular tachycardia (n=345). Percutaneous ventricular assist device (PVAD) vs. Intra-aortic balloon pump (IABP) was evaluated on Index mortality (p=0.001). Mechanical support with PVAD during ventricular tachycardia ablation was associated with lower index mortality compared to IABP (6.5% vs. 19.1%; P=0.001).