Introduction:
Ventricular tachycardia (VT) ablation procedures in patients with progressed heart failure (HF) are known to be complex and associated with a high periprocedural risk of hemodynamic decompensation and mortality. The problem of unmappable VTs due to hemodynamic instability results in moderate success rates regarding arrhythmia-freedom. Use of mechanical circulatory support (MCS) systems had been suggested to improve clinical outcome but coming along with an increased risk of periprocedural complications. Objective of this analysis was to evaluate the impact of a planned prophylactic MCS use in VT ablation (VT-A) in a pre-selected cohort with respect to safety and mid-term efficacy.
Ventricular tachycardia (VT) ablation procedures in patients with progressed heart failure (HF) are known to be complex and associated with a high periprocedural risk of hemodynamic decompensation and mortality. The problem of unmappable VTs due to hemodynamic instability results in moderate success rates regarding arrhythmia-freedom. Use of mechanical circulatory support (MCS) systems had been suggested to improve clinical outcome but coming along with an increased risk of periprocedural complications. Objective of this analysis was to evaluate the impact of a planned prophylactic MCS use in VT ablation (VT-A) in a pre-selected cohort with respect to safety and mid-term efficacy.
Methods:
We included n= 12 patients with an indication for a VT-A. Inclusion criteria comprised either a PAAIN-ESD score ≥15 or a prior VT procedure with an unmappable VT / hemodynamic decompensation. VT-A was planned with prior vascular screening for MCS eligibility and exclusion of other contraindications for MCS use. MCS was routinely performed by a impella device (2.5 or CP). Patient characteristics are depicted in the table.
We included n= 12 patients with an indication for a VT-A. Inclusion criteria comprised either a PAAIN-ESD score ≥15 or a prior VT procedure with an unmappable VT / hemodynamic decompensation. VT-A was planned with prior vascular screening for MCS eligibility and exclusion of other contraindications for MCS use. MCS was routinely performed by a impella device (2.5 or CP). Patient characteristics are depicted in the table.
Results:
MCS-supported VT-A was successfully performed with the use 3 different mapping systems (Rhythmia HDx, n=4; CARTO3, n=7; EnSite Precision, n=1). VT inducibility was reduced from 9 to 3 patients pre vs. post ablation. Postprocedural lactate, WBC and hemoglobin were not significantly altered, while mean pH-value was lower (7.3 vs. 7.4) and mean-CRP was higher (2.3 mg/dl vs. 0.3 mg/dl) compared to pre-procedural values. Periprocedural (30days) complications contained pericardial effusion (n=1), vascular complication (n=1), cardiovascular death (n=1; due to progressed cardiogenic shock). Freedom from VT/VF was 92% during a mean-FU of 11±9 months.
MCS-supported VT-A was successfully performed with the use 3 different mapping systems (Rhythmia HDx, n=4; CARTO3, n=7; EnSite Precision, n=1). VT inducibility was reduced from 9 to 3 patients pre vs. post ablation. Postprocedural lactate, WBC and hemoglobin were not significantly altered, while mean pH-value was lower (7.3 vs. 7.4) and mean-CRP was higher (2.3 mg/dl vs. 0.3 mg/dl) compared to pre-procedural values. Periprocedural (30days) complications contained pericardial effusion (n=1), vascular complication (n=1), cardiovascular death (n=1; due to progressed cardiogenic shock). Freedom from VT/VF was 92% during a mean-FU of 11±9 months.
Conclusion:
In this cohort of VT-A patients planned prophylactic MCS-support is feasible with different 3D-mapping systems and resulted in successful procedural outcome with low complication rate and moderate-high success rate. These results suggest a potential benefit by prophylactic MCS in selected patients.
In this cohort of VT-A patients planned prophylactic MCS-support is feasible with different 3D-mapping systems and resulted in successful procedural outcome with low complication rate and moderate-high success rate. These results suggest a potential benefit by prophylactic MCS in selected patients.
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