Abstract 281 Near-Infrared Spectroscopy for Cerebral Monitoring of Adults during VT ablation

Background:

Cerebral near-infrared spectroscopy (NIRS) is a long-established tool for non-invasive monitoring of cerebral tissue oxygenation (TOI) and perfusion especially in children undergoing heart surgery or in the context of traumatic brain injury. A threshold for %ΔTOI of −13 was identified to reliably identify patients with cerebral ischemia. Even in patients with sustained ventricular tachycardia (VT) undergoing VT ablation monitoring of hemodynamics is crucial. The goal of this study was to evaluate the ability and performance of non-invasive NIRS monitoring during VT ablation to identify reduced cerebral circulation or brain ischemia.

Methods:

Between November 2020 and January 2021 patients with VT and structural heart disease undergoing ablation were included. In a first step, 20 patients were included. The NIRO 300 was incorporated into an established multimodal monitoring system enabling observations of cerebral hemodynamic changes under highly controlled conditions. Changes in oxygenated (O2Hb) and deoxygenated hemoglobin (HHb), tissue oxygenation index (TOI) and total Hb index (THI) were investigated and correlated with clinical and procedural characteristics.

Results:

Of the 20 patients 8 had ischemic cardiomyopathies. Mean LVEF was 37 ± 12%, mean procedure time was 185 ± 46 min, mean ablation time 38 ± 21 min. All patients underwent procedure during analgosedation. 3 patients were non-inducible. In the other patients mean inducible VTs were 2.1 ± 1.6 and mean cycle length was 382 ± 46 ms. 3 patients had hemodynamic relevant VT and induced VT was terminated several seconds after induction. All other patients were mapped using a combination of substrate mapping and activation mapping. 11 patients had %ΔTOI of more than 13% (55%). Mean %ΔTOI was 21.3 ± 17.4. Mean %ΔTHI was 40.1 ± 23.9%. Patients with significant %ΔTOI were more often among patients with iCMP and admitted with acute heart failure. LVEF, cycle length of VT, and procedural duration were not significantly different among both groups. 6 patients had VT recurrences during a mean follow-up of 23 ± 3 months.

Conclusions:

A significant part of all patients during VT ablation revealed relevant %ΔTOI indicating cerebral ischemia. Broader application of hemodynamic support tools can be discussed. This finding is hypothesis-generating and is influenced by small sample size.

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02302-4
Near-Infrared Spectroscopy for Cerebral Monitoring of Adults during VT ablation
J. Müller¹, K. Nentwich², A. Berkovitz², P. Halbfaß³, I. Chakarov⁴, S. Barth⁵, T. Deneke²
¹Herz- und Gefäß-Klinik Campus Bad Neustadt, Bad Neustadt a. d. Saale; ²Klinik für Kardiologie II / Interventionelle Elektrophysiologie, RHÖN-KLINIKUM AG Campus Bad Neustadt, Bad Neustadt a. d. Saale; ³Klinik für Kardiologie, Klinikum Oldenburg AöR, Oldenburg; ⁴Kardiologie, RHÖN-KLINIKUM AG Campus Bad Neustadt, Bad Neustadt a. d. Saale; ⁵Klinik für Kardiologie I - Interventionelle Kardiologie und kardiale Bildgebung, RHÖN-KLINIKUM AG Campus Bad Neustadt, Bad Neustadt a. d. Saale;
Background: Cerebral near-infrared spectroscopy (NIRS) is a long-established tool for non-invasive monitoring of cerebral tissue oxygenation (TOI) and perfusion especially in children undergoing heart surgery or in the context of traumatic brain injury. A threshold for %ΔTOI of −13 was identified to reliably identify patients with cerebral ischemia. Even in patients with sustained ventricular tachycardia (VT) undergoing VT ablation monitoring of hemodynamics is crucial. The goal of this study was to evaluate the ability and performance of non-invasive NIRS monitoring during VT ablation to identify reduced cerebral circulation or brain ischemia. Methods: Between November 2020 and January 2021 patients with VT and structural heart disease undergoing ablation were included. In a first step, 20 patients were included. The NIRO 300 was incorporated into an established multimodal monitoring system enabling observations of cerebral hemodynamic changes under highly controlled conditions. Changes in oxygenated (O2Hb) and deoxygenated hemoglobin (HHb), tissue oxygenation index (TOI) and total Hb index (THI) were investigated and correlated with clinical and procedural characteristics. Results: Of the 20 patients 8 had ischemic cardiomyopathies. Mean LVEF was 37 ± 12%, mean procedure time was 185 ± 46 min, mean ablation time 38 ± 21 min. All patients underwent procedure during analgosedation. 3 patients were non-inducible. In the other patients mean inducible VTs were 2.1 ± 1.6 and mean cycle length was 382 ± 46 ms. 3 patients had hemodynamic relevant VT and induced VT was terminated several seconds after induction. All other patients were mapped using a combination of substrate mapping and activation mapping. 11 patients had %ΔTOI of more than 13% (55%). Mean %ΔTOI was 21.3 ± 17.4. Mean %ΔTHI was 40.1 ± 23.9%. Patients with significant %ΔTOI were more often among patients with iCMP and admitted with acute heart failure. LVEF, cycle length of VT, and procedural duration were not significantly different among both groups. 6 patients had VT recurrences during a mean follow-up of 23 ± 3 months. Conclusions: A significant part of all patients during VT ablation revealed relevant %ΔTOI indicating cerebral ischemia. Broader application of hemodynamic support tools can be discussed. This finding is hypothesis-generating and is influenced by small sample size.
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