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Hashimoto K, Akkawi AR, Ghazal M, Briasoulis A, Kuno T. Impact of mechanical circulatory support on in-hospital outcomes among patients with ventricular tachycardia requiring ablation. Artif Organs 2024. [PMID: 39345216 DOI: 10.1111/aor.14877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 09/12/2024] [Accepted: 09/16/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Ventricular tachycardia (VT) ablation is a high-risk procedure, particularly due to the potential for hemodynamic instability. Mechanical circulatory support (MCS) is increasingly utilized to manage these risks. This study investigated the in-hospital outcomes of VT ablation with MCS use, emphasizing its impact on mortality and procedural complications. METHODS We retrospectively analyzed patients undergoing VT ablation from 2019 to 2020, using the National Inpatient Sample data. Patients aged 18 years and over were included. MCS includes a percutaneous left ventricular assist device (pLVAD), extracorporeal membrane oxygenation (ECMO), and intraaortic balloon pump (IABP). We also conducted a subgroup analysis for patients experiencing cardiogenic shock (CS). The primary outcome was in-hospital mortality; secondary outcomes included acute kidney injury (AKI), AKI-requiring dialysis, any bleeding events, gastrointestinal bleeding, ischemic stroke, heart transplant, and durable LVAD (dLVAD) utilization. RESULTS We included 14 450 patients, of whom 6.5% utilized MCS. The MCS group showed a higher in-hospital mortality rate than the non-MCS group (24% vs. 2%, p < 0.01). Secondary outcomes showed statistically higher rates in the MCS group compared to the non-MCS groups. Stratification by MCS modality did not affect outcomes except that pLVAD was associated with lower rates of AKI. In the CS subgroup, the MCS group exhibited significantly higher mortality compared to the non-MCS group (32% vs. 8.4%, p < 0.01). CONCLUSIONS The use of MCS during VT ablation is associated with increased in-hospital mortality, underscoring the severity of cases requiring such support. These findings show the need for careful assessment and optimal usage of MCS to enhance patient outcomes.
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Affiliation(s)
- Kenji Hashimoto
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Abdul Rahman Akkawi
- Department of Internal Medicine, Kansas University School of Medicine-Wichita, Wichita, Kansas, USA
| | - Mohamad Ghazal
- Department of Internal Medicine, Albany Medical College, Albany, New York, USA
| | - Alexandros Briasoulis
- Department of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, Iowa City, Iowa, USA
| | - Toshiki Kuno
- Division of Cardiovascular Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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2
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Kautzner J, Hašková J, Stojadinovič P, Peichl P, Wichterle D. Percutaneous mechanical support in catheter ablation of ventricular arrhythmias: hype or hope? Europace 2024; 26:euae186. [PMID: 39028767 PMCID: PMC11259133 DOI: 10.1093/europace/euae186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/27/2024] [Indexed: 07/21/2024] Open
Abstract
Catheter ablation (CA) has become an established treatment strategy for managing recurrent ventricular tachycardias (VTs) in patients with structural heart disease. In recent years, percutaneous mechanical circulatory support (PMCS) devices have been increasingly used intra-operatively to improve the ablation outcome. One indication would be rescue therapy for patients who develop haemodynamic deterioration during the ablation. However, more efforts are focused on identifying subjects who are at high risk of such deterioration and could benefit from the pre-emptive use of the PMCS. The third reason to use PMCS could be the inability to identify diffuse substrate, especially in non-ischaemic cardiomyopathy. This paper reviews available experiences using various types of PMCS in different clinical scenarios. 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. Our data suggest that even in patients with severe left ventricular dysfunction, the substrate modification can be performed without the need for general anaesthesia and risk of haemodynamic decompensation. In end-stage heart failure associated with the electrical storm, implantation of a left ventricular assist device (or PMCS with a transition to the left ventricular assist device) might be the preferred strategy before CA. In high-risk patients who are not potential candidates for these treatment options, radiotherapy could be considered as a bail-out treatment of recurrent VTs. These approaches should be studied in prospective trials.
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Affiliation(s)
- Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, Prague 140 21, Czech Republic
- Department of Internal Medicine I – Cardiology, Palacký University Medical School, Olomouc, Czech Republic
| | - Jana Hašková
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, Prague 140 21, Czech Republic
- Department of Internal Medicine I – Cardiology, Palacký University Medical School, Olomouc, Czech Republic
| | - Predrag Stojadinovič
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, Prague 140 21, Czech Republic
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, Prague 140 21, Czech Republic
| | - Dan Wichterle
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, Prague 140 21, Czech Republic
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3
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Freedman BL, Maher TR, Tracey M, Santangeli P, d'Avila A. Procedural Adaptations to Avoid Haemodynamic Instability During Catheter Ablation of Scar-related Ventricular Tachycardia. Arrhythm Electrophysiol Rev 2023; 12:e20. [PMID: 37465104 PMCID: PMC10350657 DOI: 10.15420/aer.2022.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/08/2022] [Indexed: 07/20/2023] Open
Abstract
Classically, catheter ablation for scar-related ventricular tachycardia (VT) relied upon activation and entrainment mapping of induced VT. Advances in post-MI therapies have led to VTs that are faster and haemodynamically less stable, because of more heterogeneous myocardial fibrosis patterns. The PAINESD score is one means of identifying patients at highest risk for haemodynamic decompensation during attempted VT induction, who may, therefore, benefit from alternative ablation strategies. One strategy is to use temporary mechanical circulatory support, although this warrants formal assessment of cost-effectiveness. A second strategy is to minimise or avoid VT induction altogether by employing a family of 'substrate'-based approaches aimed at identifying VT isthmuses during sinus or paced rhythm. Substrate mapping techniques are diverse, and focus on the timing, morphology and amplitude of local ventricular electrograms - sometimes aided by advanced non-invasive cardiac imaging modalities. In this review, the evolution of VT ablation over time is discussed, with an emphasis on procedural adaptations to the challenge of haemodynamic instability.
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Affiliation(s)
- Benjamin L Freedman
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
| | - Timothy R Maher
- Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
| | | | - Pasquale Santangeli
- Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, US
| | - Andre d'Avila
- Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
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4
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Aryana A, Sarcon A, Bowers MR, O'Neill PG, Gandhavadi M, d'Avila A. Three-dimensional mapping, recording and ablation in simulated and induced ventricular tachyarrhythmias during mechanical circulatory support using the percutaneous heart pump. JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY : AN INTERNATIONAL JOURNAL OF ARRHYTHMIAS AND PACING 2023; 66:99-107. [PMID: 34988846 DOI: 10.1007/s10840-021-01098-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/22/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Due to their internal rotating magnets, conventional impeller-driven percutaneous ventricular assist devices (PVADs) yield high-frequency electrogram artifact and electromagnetic interference (EMI) when used with magnetic-based 3D electroanatomic mapping systems. The new percutaneous heart pump (PHP; Abbott, Chicago, IL) is a 14-French, 5-L/min, impeller axial-flow PVAD with a novel design that utilizes an external motor. METHODS We evaluated the feasibility of 3D mapping and radiofrequency ablation (RFA) in vivo during PHP mechanical circulatory support (MCS) in simulated ventricular tachycardia (pacing at 300 ms) and ventricular flutter (VFL, pacing at 200 ms) and also during ventricular fibrillation (VF) in a porcine model. Anterograde (right ventricular), transseptal, retrograde, and epicardial right and left ventricular 3D mapping (EnSite/CARTO) and RFA were performed in 6 swine using high-density mapping and force-sensing RFA catheters (TactiCath/ThermoCool). Surface and intracardiac electrograms and 3D maps were analyzed for noise/interference with and without MCS using PHP in sinus rhythm and simulated VT/VFL and VF. RESULTS Mapping and RFA proved feasible in the presence of MCS using PHP. The mean arterial pressure in sinus rhythm was 55 ± 2 mmHg (baseline) and 84 ± 4 mmHg during MCS with PHP and well-maintained during simulated VT (73 ± 8 mmHg) and VFL (65 ± 2 mmHg) and even in VF (65 ± 5 mmHg). No electrogram noise/artifact, EMI, or 3D map distortions were observed during mapping/RFA with either of two mapping systems. CONCLUSIONS Endocardial and epicardial 3D mapping and RFA in the presence of PHP are feasible and offer significant MCS during simulated VT/VFL and VF. Furthermore, PHP yielded no electrogram noise/artifact, EMI, or 3D mapping distortions in conjunction with magnetic-based 3D mapping systems.
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Affiliation(s)
- Arash Aryana
- Cardiovascular Services, Mercy General Hospital and Dignity Health Heart and Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA, 95819, USA.
| | - Anna Sarcon
- UCSF Cardiac Electrophysiology and Arrhythmia Service, San Francisco, CA, USA
| | - Mark R Bowers
- Cardiovascular Services, Mercy General Hospital and Dignity Health Heart and Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA, 95819, USA
| | - Padraig Gearoid O'Neill
- Cardiovascular Services, Mercy General Hospital and Dignity Health Heart and Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA, 95819, USA
| | - Maheer Gandhavadi
- Cardiovascular Services, Mercy General Hospital and Dignity Health Heart and Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA, 95819, USA
| | - André d'Avila
- The Harvard Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
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5
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Complications of catheter ablation for ventricular tachycardia. JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY : AN INTERNATIONAL JOURNAL OF ARRHYTHMIAS AND PACING 2023; 66:221-233. [PMID: 36053374 DOI: 10.1007/s10840-022-01357-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/20/2022] [Indexed: 11/09/2022]
Abstract
With the increasing literature demonstrating benefits of catheter ablation for ventricular tachycardia (VT), the number of patients undergoing VT ablation has increased dramatically. As VT ablation is being performed more routinely, operators must be aware of potential complications of VT ablation. This review delves deeper into the practice of VT ablation with a focus on periprocedural complications.
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6
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Sabbag A, Nissan J, Beinart R, Sternik L, Kassif I, Kogan A, Ram E, Nof E. Early de-cannulation from extracorporeal membrane oxygenation following ventricular tachycardia radiofrequency ablation. Front Cardiovasc Med 2022; 9:998079. [PMID: 36329994 PMCID: PMC9622793 DOI: 10.3389/fcvm.2022.998079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives Ventricular tachycardia ablation (VTA) with hemodynamic compromise presents a challenge. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support allows the safe completion of the procedure. There are limited data regarding the safety of weaning off VA-ECMO at the end of the procedure. We report our experience with early VA-ECMO de-cannulation after VTA. Materials and methods All patients undergoing VA-ECMO-assisted VTA, between January 2013 and December 2020 at a large tertiary center were included. Clinical characteristics, history of arrhythmia, procedural details, and outcomes were collected. Patients weaned from VA-ECMO immediately at the end of the procedure were compared to those that were de-cannulated at a later time. Results A total of 46 patients (93.5% male, age 62 ± 10 years) were ablated with VA-ECMO support. Most had ischemic cardiomyopathy (65%) and (70%) presented with VT storm. The clinical VT was induced in the majority of patients (76%). A total of 99 VTs were induced of which 76 (77%) were targeted and successfully ablated. Non-inducibility was achieved in 74% of cases and most patients (83%) were de-cannulated at the end of the procedure on the procedure table. Survival at 1 year was higher among early de-cannulated patients (86 vs. 38% [log-rank p-value < 0.001]). At 1-year follow-up, 91.3% of surviving patients were free of appropriate ICD shocks. Conclusion De-cannulation from VA-ECMO may be done immediately at the conclusion of VTA in most cases. Failure to timely wean off VA-ECMO is a strong predictor of mortality.
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Affiliation(s)
- Avi Sabbag
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Johnatan Nissan
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Roy Beinart
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Leonid Sternik
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Igal Kassif
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Alexander Kogan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Eilon Ram
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Eyal Nof
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- *Correspondence: Eyal Nof,
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7
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Tavazzi G, Dammassa V, Colombo CNJ, Arbustini E, Castelein T, Balik M, Vandenbriele C. Mechanical circulatory support in ventricular arrhythmias. Front Cardiovasc Med 2022; 9:987008. [PMID: 36304552 PMCID: PMC9593033 DOI: 10.3389/fcvm.2022.987008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/15/2022] [Indexed: 11/27/2022] Open
Abstract
In atrial and ventricular tachyarrhythmias, reduced time for ventricular filling and loss of atrial contribution lead to a significant reduction in cardiac output, resulting in cardiogenic shock. This may also occur during catheter ablation in 11% of overall procedures and is associated with increased mortality. Managing cardiogenic shock and (supra) ventricular arrhythmias is particularly challenging. Inotropic support may exacerbate tachyarrhythmias or accelerate heart rate; antiarrhythmic drugs often come with negative inotropic effects, and electrical reconversions may risk worsening circulatory failure or even cardiac arrest. The drop in native cardiac output during an arrhythmic storm can be partly covered by the insertion of percutaneous mechanical circulatory support (MCS) devices guaranteeing end-organ perfusion. This provides physicians a time window of stability to investigate the underlying cause of arrhythmia and allow proper therapeutic interventions (e.g., percutaneous coronary intervention and catheter ablation). Temporary MCS can be used in the case of overt hemodynamic decompensation or as a “preemptive strategy” to avoid circulatory instability during interventional cardiology procedures in high-risk patients. Despite the increasing use of MCS in cardiogenic shock and during catheter ablation procedures, the recommendation level is still low, considering the lack of large observational studies and randomized clinical trials. Therefore, the evidence on the timing and the kinds of MCS devices has also scarcely been investigated. In the current review, we discuss the available evidence in the literature and gaps in knowledge on the use of MCS devices in the setting of ventricular arrhythmias and arrhythmic storms, including a specific focus on pathophysiology and related therapies.
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Affiliation(s)
- Guido Tavazzi
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy,Department of Anaesthesia, Intensive Care and Pain Therapy, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy,*Correspondence: Guido Tavazzi
| | - Valentino Dammassa
- PhD in Experimental Medicine, University of Pavia, Pavia, Italy,Adult Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom
| | | | - Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Thomas Castelein
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Martin Balik
- Department of Anesthesiology and Intensive Care, First Medical Faculty and General University Hospital, Charles University in Prague, Prague, Czechia
| | - Christophe Vandenbriele
- Adult Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom,Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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8
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Grimaldi M, Marino MM, Vitulano N, Quadrini F, Troisi F, Caporusso N, Perniciaro V, Caruso R, Duni N, Cecere G, Martinelli A, Guida P, Del Monte V, Langialonga T, Di Biase L, Di Monaco A. Cardiopulmonary Support During Catheter Ablation of Ventricular Arrhythmias With Hemodynamic Instability: The Role of Inducibility. Front Cardiovasc Med 2021; 8:747858. [PMID: 34746263 PMCID: PMC8563579 DOI: 10.3389/fcvm.2021.747858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Catheter ablation is a treatment option for sustained ventricular tachycardias (VTs) that are refractory to pharmacological treatment; however, patients with fast VT and electrical storm (ES) are at risk for cardiogenic shock. We report our experience using cardiopulmonary support with extracorporeal membrane oxygenation (ECMO) during catheter ablation of VT. Methods: Sixty-two patients (mean age 68 ± 9 years; 94% male) were referred to our center for catheter ablation of repeated episodes of hemodynamically unstable ventricular arrhythmias. ES was defined as the occurrence of three or more VT/ventricular fibrillation episodes requiring electrical cardioversion or defibrillation in a 24-h period. All patients had hemodynamically unstable VTs. Results: Thirty-one patients (group 1) performed catheter ablation without ECMO support and 31 patients (group 2) with ECMO support. At the end of the procedure, ventricular inducibility was not performed in 16 patients of group 1 (52%) due to significant hemodynamic instability. Ventricular inducibility was performed in the other 15 patients (48%); polymorphic VTs were inducible in eight patients. In group 2, VTs were not inducible in 29 patients (93%); polymorphic VTs were inducible in two patients. The median follow-up duration was 24 months. Four patients of group 1 (13%) and five patients of group 2 (16%) died due to refractory heart failure. An implantable cardioverter-defibrillator intervention (shock or antitachycardia pacing) was documented in 13 patients of group 1 (42%) and six patients of group 2 (19%). Conclusions: Extracorporeal membrane oxygenation support during catheter ablation for hemodynamically unstable VTs is a useful tool to prevent acute procedural heart failure and to reduce arrhythmic burden.
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Affiliation(s)
- Massimo Grimaldi
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | | | - Nicola Vitulano
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Federico Quadrini
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Federica Troisi
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Nicola Caporusso
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Anestesia e Rianimazione, Bari, Italy
| | - Vera Perniciaro
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Rosa Caruso
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Nicola Duni
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Giacomo Cecere
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Alberto Martinelli
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Pietro Guida
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Vito Del Monte
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Anestesia e Rianimazione, Bari, Italy
| | - Tommaso Langialonga
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy
| | - Luigi Di Biase
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX, United States.,Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Antonio Di Monaco
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Bari, Italy.,Dipartimento di Medicina Clinica e Sperimentale, Universitá di Foggia, Foggia, FG, Italy
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9
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Ben Avraham B, Crespo-Leiro MG, Filippatos G, Gotsman I, Seferovic P, Hasin T, Potena L, Milicic D, Coats AJS, Rosano G, Ruschitzka F, Metra M, Anker S, Altenberger J, Adamopoulos S, Barac YD, Chioncel O, De Jonge N, Elliston J, Frigeiro M, Goncalvesova E, Grupper A, Hamdan R, Hammer Y, Hill L, Itzhaki Ben Zadok O, Abuhazira M, Lavee J, Mullens W, Nalbantgil S, Piepoli MF, Ponikowski P, Ristic A, Ruhparwar A, Shaul A, Tops LF, Tsui S, Winnik S, Jaarsma T, Gustafsson F, Ben Gal T. HFA of the ESC Position paper on the management of LVAD supported patients for the non LVAD specialist healthcare provider Part 1: Introduction and at the non-hospital settings in the community. ESC Heart Fail 2021; 8:4394-4408. [PMID: 34519177 PMCID: PMC8712781 DOI: 10.1002/ehf2.13588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/23/2021] [Accepted: 08/19/2021] [Indexed: 12/28/2022] Open
Abstract
The accepted use of left ventricular assist device (LVAD) technology as a good alternative for the treatment of patients with advanced heart failure together with the improved survival of the LVAD‐supported patients on the device and the scarcity of donor hearts has significantly increased the population of LVAD‐supported patients. The expected and non‐expected device‐related and patient–device interaction complications impose a significant burden on the medical system exceeding the capacity of the LVAD implanting centres. The ageing of the LVAD‐supported patients, mainly those supported with the ‘destination therapy’ indication, increases the risk for those patients to experience comorbidities common in the older population. The probability of an LVAD‐supported patient presenting with medical emergency to a local emergency department, internal, or surgical ward of a non‐LVAD implanting centre is increasing. The purpose of this trilogy is to supply the immediate tools needed by the non‐LVAD specialized physician: ambulance clinicians, emergency ward physicians, general cardiologists, internists, anaesthesiologists, and surgeons, to comply with the medical needs of this fast‐growing population of LVAD‐supported patients. The different issues discussed will follow the patient's pathway from the ambulance to the emergency department and from the emergency department to the internal or surgical wards and eventually to the discharge home from the hospital back to the general practitioner. In this first part of the trilogy on the management of LVAD‐supported patients for the non‐LVAD specialist healthcare provider, after the introduction on the assist devices technology in general, definitions and structured approach to the assessment of the LVAD‐supported patient in the ambulance and emergency department is presented including cardiopulmonary resuscitation for LVAD‐supported patients.
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Affiliation(s)
- Binyamin Ben Avraham
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marisa Generosa Crespo-Leiro
- Complexo Hospitalario Universitario A, Coruña (CHUAC), CIBERCV, Instituto de Investigacion Biomedica A Coruña (INIBIC), Universidad de a Coruña (UDC) La Coruña, A Coruña, Spain
| | - Gerasimos Filippatos
- Heart Failure Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,School of Medicine, University of Cyprus, Nicosia, Cyprus
| | - Israel Gotsman
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel
| | - Petar Seferovic
- Serbian Academy of Sciences and Arts, Heart Failure Center, Faculty of Medicine, Belgrade University Medical Center, Belgrade, Serbia
| | - Tal Hasin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Luciano Potena
- Heart and Lung Transplant Program, Bologna University Hospital, Bologna, Italy
| | - Davor Milicic
- Department for Cardiovascular Diseases, Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | | | - Giuseppe Rosano
- Cardiovascular Clinical Academic Group, St George's Hospitals NHS Trust, University of London, London, UK.,IRCCS San Raffaele Pisana, Rome, Italy
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital, University Heart Center, Zurich, Switzerland
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Stefan Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Johann Altenberger
- SKA-Rehabilitationszentrum Großgmain, Salzburger Straße 520, Großgmain, 5084, Austria
| | - Stamatis Adamopoulos
- Heart Failure and Heart Transplantation Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Yaron D Barac
- Department of Cardiothoracic Surgery, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, University of Medicine Carol Davila, Bucharest, Romania
| | - Nicolaas De Jonge
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeremy Elliston
- Anesthesiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maria Frigeiro
- Transplant Center and De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | | | - Avishay Grupper
- Heart Failure Institute, Lev Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Righab Hamdan
- Department of Cardiology, Beirut Cardiac Institute, Beirut, Lebanon
| | - Yoav Hammer
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Osnat Itzhaki Ben Zadok
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Abuhazira
- Department of Cardiothoracic Surgery, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Lavee
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel
| | - Wilfried Mullens
- Ziekenhuis Oost Limburg, Genk, University Hasselt, Hasselt, Belgium
| | | | - Massimo F Piepoli
- Heart Failure Unit, Cardiology, G. da Saliceto Hospital, Piacenza, Italy
| | - Piotr Ponikowski
- Centre for Heart Diseases, University Hospital, Wroclaw, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Arsen Ristic
- Department of Cardiology of the Clinical Center of Serbia, Belgrade University School of Medicine, Belgrade, Serbia
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Aviv Shaul
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Steven Tsui
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Stephan Winnik
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Tiny Jaarsma
- Department of Nursing, Faculty of Medicine and Health Sciences, University of Linköping, Linköping, Sweden
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Ben Gal T, Ben Avraham B, Milicic D, Crespo-Leiro MG, Coats AJS, Rosano G, Seferovic P, Ruschitzka F, Metra M, Anker S, Filippatos G, Altenberger J, Adamopoulos S, Barac YD, Chioncel O, de Jonge N, Elliston J, Frigerio M, Goncalvesova E, Gotsman I, Grupper A, Hamdan R, Hammer Y, Hasin T, Hill L, Itzhaki Ben Zadok O, Abuhazira M, Lavee J, Mullens W, Nalbantgil S, Piepoli MF, Ponikowski P, Potena L, Ristic A, Ruhparwar A, Shaul A, Tops LF, Tsui S, Winnik S, Jaarsma T, Gustafsson F. Guidance on the management of left ventricular assist device (LVAD) supported patients for the non-LVAD specialist healthcare provider: executive summary. Eur J Heart Fail 2021; 23:1597-1609. [PMID: 34409711 DOI: 10.1002/ejhf.2327] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/10/2021] [Accepted: 08/05/2021] [Indexed: 12/28/2022] Open
Abstract
The accepted use of left ventricular assist device (LVAD) technology as a good alternative for the treatment of patients with advanced heart failure together with the improved survival of patients on the device and the scarcity of donor hearts has significantly increased the population of LVAD supported patients. Device-related, and patient-device interaction complications impose a significant burden on the medical system exceeding the capacity of LVAD implanting centres. The probability of an LVAD supported patient presenting with medical emergency to a local ambulance team, emergency department medical team and internal or surgical wards in a non-LVAD implanting centre is increasing. The purpose of this paper is to supply the immediate tools needed by the non-LVAD specialized physician - ambulance clinicians, emergency ward physicians, general cardiologists, and internists - to comply with the medical needs of this fast-growing population of LVAD supported patients. The different issues discussed will follow the patient's pathway from the ambulance to the emergency department, and from the emergency department to the internal or surgical wards and eventually back to the general practitioner.
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Affiliation(s)
- Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Binyamin Ben Avraham
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Davor Milicic
- Department for Cardiovascular Diseases, Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Marisa G Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC), CIBERCV, Instituto de Investigacion Biomedica A Coruña (INIBIC), Universidad de a Coruña (UDC), La Coruña, Spain
| | | | - Giuseppe Rosano
- Cardiovascular Clinical Academic Group, St George's Hospitals NHS Trust University of London, London, UK.,IRCCS San Raffaele Pisana, Rome, Italy
| | - Petar Seferovic
- Serbian Academy of Sciences and Arts, Heart Failure Center, Faculty of Medicine, Belgrade University Medical Center, Belgrade, Serbia
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital, University Heart Center, Zurich, Switzerland
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Stefan Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gerasimos Filippatos
- Heart Failure Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,School of Medicine, University of Cyprus, Nicosia, Cyprus
| | | | - Stamatis Adamopoulos
- Heart Failure and Heart Transplantation Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Yaron D Barac
- Department of Cardiothoracic Surgery, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C.C. Iliescu', Bucharest, Romania.,University of Medicine Carol Davila, Bucharest, Romania
| | - Nicolaas de Jonge
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeremy Elliston
- Anesthesiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maria Frigerio
- Transplant Center and De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | | | - Israel Gotsman
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel
| | - Avishai Grupper
- Heart Failure Institute, Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Righab Hamdan
- Department of Cardiology, Beirut Cardiac Institute, Beirut, Lebanon
| | - Yoav Hammer
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Hasin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Osnat Itzhaki Ben Zadok
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Abuhazira
- Department of Cardiothoracic Surgery, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Lavee
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel
| | - Wilfried Mullens
- Ziekenhuis Oost Limburg, Genk, Belgium.,University Hasselt, Hasselt, Belgium
| | - Sanem Nalbantgil
- Department of Cardiology, Ege University Hospital, Izmir, Turkey
| | - Massimo F Piepoli
- Heart Failure Unit, Cardiology, G. da Saliceto Hospital, Piacenza, Italy
| | - Piotr Ponikowski
- Centre for Heart Diseases, University Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Luciano Potena
- Heart and Lung Transplant Program, Bologna University Hospital, Bologna, Italy
| | - Arsen Ristic
- Department of Cardiology of the Clinical Center of Serbia, Belgrade University School of Medicine, Belgrade, Serbia
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Aviv Shaul
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Steven Tsui
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Stephan Winnik
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Tiny Jaarsma
- Department of Nursing, Faculty of Medicine and Health Sciences, University of Linköping, Linköping, Sweden
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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11
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Mariani S, Napp LC, Kraaier K, Li T, Bounader K, Hanke JS, Dogan G, Schmitto JD, Lorusso R. Prophylactic mechanical circulatory support for protected ventricular tachycardia ablation: A meta-analysis of the literature. Artif Organs 2021; 45:987-997. [PMID: 33616221 DOI: 10.1111/aor.13945] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/30/2020] [Accepted: 02/14/2021] [Indexed: 12/15/2022]
Abstract
Acute hemodynamic decompensation (AHD) during ventricular tachycardia (VT) ablation occurs in about 11% of cases. Prophylactic use of temporary mechanical circulatory support (pro-tMCS) has been applied to prevent AHD during VT ablation, but evidence supporting this practice is still lacking. This systematic review and meta-analysis assessed the procedural characteristics and outcomes of pro-tMCS for VT ablation. PubMed/Medline was screened until February 2020. Articles including adults receiving pro-tMCS for VT ablation were included, and a meta-analysis to compare proMCS and no-tMCS was performed. Primary outcome was in-hospital/30-day mortality. Five observational studies presenting 400 procedures (pro-tMCS: n = 187; no-tMCS: n = 213) were included. Baseline characteristics were comparable between groups. Impella and TandemHeart were used in 86.6% and 13.4% of cases, respectively. In the pro-tMCS group, more VTs were induced (mean difference: 0.52, confidence interval [CI]: 0.26-0.77, P < .0001), and patients remained in VT on average for 24.04 minutes longer (CI: 18.28-29.80, P < .00001). Procedural success was comparable between groups, as was VT recurrence. Pro-tMCS patients had an odds ratio of 0.55 (CI: 0.28-1.05, P = .07) for in-hospital/30-day mortality and 0.55 (CI: 0.32-0.94, P = .03) for mortality at follow-up. Sixty-four percent of no-tMCS patients received rescue tMCS. The most common tMCS-related complications were bleeding events. Pro-tMCS allowed for a prolonged time on VTs and the induction of more VTs. Although these advantages were not associated with differences in procedural success, VT recurrence, or in-hospital/30-day mortality in the overall population, pro-tMCS might improve long-term survival. Further prospective studies are urgently needed to confirm these results.
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Affiliation(s)
- Silvia Mariani
- Cardio-Thoracic Surgery Department, Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Karin Kraaier
- Department of Cardiology, Hart-en Vaatcentrum Leeuwarden, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Tong Li
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Karl Bounader
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Günes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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12
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Ding WY, Pearman CM, Bonnett L, Adlan A, Chin SH, Denham N, Modi S, Todd D, Hall MCS, Mahida S. Complication rates following ventricular tachycardia ablation in ischaemic and non-ischaemic cardiomyopathies: a systematic review. J Interv Card Electrophysiol 2021; 63:59-67. [PMID: 33512605 PMCID: PMC8755671 DOI: 10.1007/s10840-021-00948-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/17/2021] [Indexed: 11/25/2022]
Abstract
Background Catheter ablation of ventricular tachycardia (VT) is associated with potential major complications, including mortality. The risk of acute complications in patients with ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM) has not been systematically evaluated. Methods PubMed was searched for studies of catheter ablation of VT published between September 2009 and September 2019. Pre-specified primary outcomes were (1) rate of major acute complications, including death, and (2) mortality rate. Results A total of 7395 references were evaluated for relevance. From this, 50 studies with a total of 3833 patients undergoing 4319 VT ablation procedures fulfilled the inclusion criteria (mean age 59 years; male 82%; 2363 [62%] ICM; 1470 [38%] NICM). The overall major complication rate in ICM cohorts was 9.4% (95% CI, 8.1–10.7) and NICM cohorts was 7.1% (95% CI, 6.0–8.3). Reported complication rates were highly variable between studies (ICM I2 = 90%; NICM I2 = 89%). Vascular complications (ICM 2.5% [95% CI, 1.9–3.1]; NICM 1.2% [95% CI, 0.7–1.7]) and cerebrovascular events (ICM 0.5% [95% CI, 0.2–0.7]; NICM, 0.1% [95% CI, 0–0.2]) were significantly higher in ICM cohorts. Acute mortality rates in the ICM and NICM cohorts were low (ICM 0.9% [95% CI, 0.5–1.3]; NICM 0.6% [95% CI, 0.3–1.0]) with the majority of overall deaths (ICM 75%; NICM 80%) due to either recurrent VT or cardiogenic shock. Conclusion Overall acute complication rates of VT ablation are comparable between ICM and NICM patients. However, the pattern and predictors of complications vary depending on the underlying cardiomyopathy. Supplementary Information The online version contains supplementary material available at 10.1007/s10840-021-00948-6.
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Affiliation(s)
- Wern Yew Ding
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
- Liverpool Centre for Cardiovascular Science, Liverpool, UK.
| | - Charles M Pearman
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
- Unit of Cardiac Physiology, Institute of Cardiovascular Sciences, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Laura Bonnett
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Ahmed Adlan
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Shui Hao Chin
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Nathan Denham
- Unit of Cardiac Physiology, Institute of Cardiovascular Sciences, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Simon Modi
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Derick Todd
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mark C S Hall
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Saagar Mahida
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool, UK
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13
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Della Bella P, Radinovic A, Limite LR, Baratto F. Mechanical circulatory support in the management of life-threatening arrhythmia. Europace 2020; 23:1166-1178. [PMID: 33382868 DOI: 10.1093/europace/euaa371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/30/2020] [Indexed: 11/12/2022] Open
Abstract
Life-threatening refractory unstable ventricular arrhythmias in presence of advanced heart failure (HF) may determine haemodynamic impairment. Haemodynamic mechanical support (HMS) in this setting has a relevant role to restore end-organ perfusion. Catheter ablation (CA) of ventricular tachycardia (VT) is effective at achieving rhythm stabilization, allowing patient's weaning from HMS, or bridging to permanent HF treatments. Acute heart decompensation during CA at anaesthesia induction in presence of advanced heart disease, in selected cases requires a preemptive HMS to prevent periprocedure adverse outcomes. Substrate ablation during sinus rhythm (SR) might be an effective strategy of ablation in presence of unstable VTs; however, in a minority of patients, it might have some limitations and might be unfeasible in some settings, including the case of the mechanical induction of several unstable VTs and the absence of ablation targets. In case of the persistent induction of unstable VTs after a previous failure of a substrate-based ablation in SR, a feasible alternative strategy of ablation might be VT activation/entrainment mapping supported by HMS. Multiple devices are available for HMS in the low-output states related to electrical storm and during CA of VT. The choice of the device is not standardized and it is based on the centres' expertise. The aim of this article is to provide an up-to-date review on HMS for the management of life-threatening arrhythmias, in the context of catheter ablation and discussing our approach to manage critical VT patients.
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Affiliation(s)
- Paolo Della Bella
- Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery, Ospedale San Raffaele, via Olgettina 60, Milan, Italy
| | - Andrea Radinovic
- Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery, Ospedale San Raffaele, via Olgettina 60, Milan, Italy
| | - Luca Rosario Limite
- Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery, Ospedale San Raffaele, via Olgettina 60, Milan, Italy
| | - Francesca Baratto
- Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery, Ospedale San Raffaele, via Olgettina 60, Milan, Italy
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14
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Campbell T, Bennett RG, Lee V, Turnbull S, Eslick A, Kruit N, Pudipeddi A, Hing A, Kizana E, Thomas SP, Kumar S. Ventricular Tachycardia Storm Ablation With Pre-Emptive Circulatory Support by Extracorporeal Membrane Oxygenation: Australian Experience. Heart Lung Circ 2020; 30:555-566. [PMID: 33153905 DOI: 10.1016/j.hlc.2020.09.926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/17/2020] [Accepted: 09/07/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can provide circulatory support in high-risk patients undergoing drug refractory ventricular tachycardia (VT) ablation procedures. We report experience using VA-ECMO in a pre-emptive approach for high-risk patients with VT storm and previously ineffective ablation procedures. METHODS AND RESULTS Four (4) patients with drug refractory ventricular tachycardia (mean age 61±3 years; left ventricular ejection fraction 21±5%) presenting for VT ablation had pre-emptive VA-ECMO. All patients during current admission had VT storm. Pre-ablation, 22 total monomorphic VTs (cycle length 402±69 ms) were induced or spontaneously observed (median of 4, IQR25-75% 1-6). At the end of the procedure, 86% of all inducible VTs were rendered non-inducible. Median hospitalisation following VA-ECMO supported ablation was 5 days (IQR25-75% 3-12). During follow-up (median 138 days [IQR25-75% 57-277]), VT recurred in one patient as an isolated episode reverted by anti-tachycardia pacing. There was a 99% reduction in VT burden post ablation. One (1) patient died of cardiogenic shock within 24 hours whilst still on VA-ECMO, all other patients were successfully weaned off support and discharged. Two (2) patients underwent cardiac transplantation at 199 and 512 days post ablation following implantation of ventricular assist devices for worsening heart failure. CONCLUSIONS The pre-emptive use of VA-ECMO for high-risk patients undergoing catheter ablation for VT storm was found to be effective in maintaining haemodynamic status, and allowing successful mapping and catheter ablation for VT.
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Affiliation(s)
- Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, NSW, Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, NSW, Australia
| | - Vickie Lee
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Samual Turnbull
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, NSW, Australia
| | - Adam Eslick
- Department of Anaesthesia, Westmead Hospital, Sydney, NSW, Australia
| | - Natalie Kruit
- Department of Anaesthesia, Westmead Hospital, Sydney, NSW, Australia
| | - Anand Pudipeddi
- Department of Anaesthesia, Westmead Hospital, Sydney, NSW, Australia
| | - Alfred Hing
- Department of Cardiothoracic Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Eddy Kizana
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Stuart P Thomas
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, NSW, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, NSW, Australia.
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15
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Mariani S, Napp LC, Lo Coco V, Delnoij TS, Luermans JG, ter Bekke RM, Timmermans C, Li T, Dogan G, Schmitto JD, Maessen J, Maesen B, Lorusso R. Mechanical circulatory support for life-threatening arrhythmia: A systematic review. Int J Cardiol 2020; 308:42-49. [DOI: 10.1016/j.ijcard.2020.03.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/07/2020] [Accepted: 03/18/2020] [Indexed: 02/06/2023]
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16
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Mapping and Ablation of Unmappable Ventricular Tachycardia, Ventricular Tachycardia Storm, and Those in Acute Myocardial Infarction. Card Electrophysiol Clin 2019; 11:675-688. [PMID: 31706474 DOI: 10.1016/j.ccep.2019.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In stable ventricular tachycardia (VT), activation mapping and entrainment mapping are the most important strategies to describe the reentrant circuit and its critical components. In many patients, however, VT is noninducible or hemodynamically unstable and unmappable. Several technological advances have broadened ablation options in unmappable VTs. Preprocedural imaging and intraprocedural imaging play an important role in location and extent of the substrate. Electroanatomic mapping with several technological improvements allows more precise electrical assessment of the substrate. A combination of imaging and electroanatomic mapping allows substantial modification of arrhythmogenic substrate in sinus rhythm or during device pacing without hemodynamic compromise.
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17
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Neuzner J, Dietze T, Paliege R, Gradaus R. Effectiveness of a percutaneous left ventricular assist device in preventing acute hemodynamic decompensation during catheter ablation of ventricular tachycardia in advanced heart failure patients: A retrospective single‐center analysis. J Cardiovasc Electrophysiol 2019; 30:2864-2868. [DOI: 10.1111/jce.14199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/01/2019] [Accepted: 09/18/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Jörg Neuzner
- B.Braun Ambulantes Herzzentrum KasselKassel Germany
| | | | - Robert Paliege
- Gemeinschaftspraxis Klinikum Kassel, Department of CardiologyKassel Germany
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18
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Kitamura T, Martin CA, Vlachos K, Martin R, Frontera A, Takigawa M, Thompson N, Cheniti G, Massouille G, Lam A, Bourier F, Duchateau J, Pambrun T, Denis A, Derval N, Hocini M, HaÏssaguerre M, Cochet H, JaÏs P, Sacher F. Substrate Mapping and Ablation for Ventricular Tachycardia in Patients with Structural Heart Disease: How to Identify Ventricular Tachycardia Substrate. J Innov Card Rhythm Manag 2019; 10:3565-3580. [PMID: 32477720 PMCID: PMC7252795 DOI: 10.19102/icrm.2019.100302] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/20/2018] [Indexed: 01/02/2023] Open
Abstract
Catheter ablation for ventricular tachycardia (VT) has been increasingly used over the past two decades in patients with structural heart disease (SHD). In these individuals, a substrate mapping strategy is being more commonly applied to identify targets for VT ablation, which has been shown to be more effective versus targeting mappable VTs alone. There are a number of substrate mapping methods in existence that aim to explore potential VT isthmuses, although their success rates vary. Most of the reported electrogram-based mapping studies have been performed with ablation catheters; meanwhile, the use of multipolar mapping catheters with smaller electrodes and closer interelectrode spacing has emerged, which allows for an assessment of detailed near-field abnormal electrograms at a higher resolution. Another recent advancement has occurred in the use of imaging techniques in VT ablation, particularly in refining the substrate. The goal of this paper is to review the key developments and limitations of current mapping strategies of substrate-based VT ablation and their outcomes. In addition, we briefly summarize the role of cardiac imaging in delineating VT substrate.
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Affiliation(s)
- Takeshi Kitamura
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France.,Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Claire A Martin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France.,Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Konstantinos Vlachos
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Ruairidh Martin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France.,Newcastle University, Newcastle-upon-Tyne, UK
| | - Antonio Frontera
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France.,San Raffaele Hospital, Milan, Italy
| | - Masateru Takigawa
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Nathaniel Thompson
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Gregoire Massouille
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Anna Lam
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Felix Bourier
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Arnaud Denis
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Nicolas Derval
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Meleze Hocini
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Michel HaÏssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Hubert Cochet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Pierre JaÏs
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Frédéric Sacher
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
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19
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Luni FK, Zungsontiporn N, Farid T, Malik SA, Khan S, Daniels J, Wu R, Link MS, Joglar JA. Percutaneous left ventricular assist device support during ablation of ventricular tachycardia: A meta-analysis of current evidence. J Cardiovasc Electrophysiol 2019; 30:886-895. [PMID: 30847997 DOI: 10.1111/jce.13907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/26/2019] [Accepted: 03/03/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Catheter ablation of ventricular tachycardia (VT) can be an effective therapy to reduce VT burden, but often it is limited by the potential for hemodynamic instability. Percutaneous left ventricular assist devices (pLVADs) have been used to maintain hemodynamic support during VT ablation but the evidence regarding its clinical impact has been inconclusive. METHODS AND RESULTS We sought to assess the clinical impact of pLVAD when used in VT ablation by conducting a meta-analysis of the current evidence. We searched Pubmed and found nine observational studies that compared clinical outcomes of VT ablation in patients with pLVAD support to controls with no pLVAD support. The pooled data did not show a significant difference in mortality between both groups, nor a difference in acute procedural success or in recurrence of VT. There was also no difference in the number of patients receiving a cardiac transplant or being enrolled in the transplant list. Although there was no difference in the ablation time between the groups, patients in the pLVAD group had a longer total procedural time and more procedure-related adverse effects. CONCLUSION This meta-analysis did not show clinical benefits from using pLVAD support during VT ablation, whereas it was associated with longer procedure times and more complications. This study was, however, limited by the observational nature of the data. In view of these data, the risk and benefit of pLVAD support during VT ablation should be considered on an individual basis.
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Affiliation(s)
- Faraz Khan Luni
- Department of Cardiology, UT Southwestern Medical Center, Dallas, Texas
| | | | - Talha Farid
- Department of Cardiology, University of Louisville, Louisville, Kentucky
| | - Sonia Ali Malik
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Sobia Khan
- Department of Cardiology, University of Louisville, Louisville, Kentucky
| | - James Daniels
- Department of Cardiology, UT Southwestern Medical Center, Dallas, Texas
| | - Richard Wu
- Department of Cardiology, UT Southwestern Medical Center, Dallas, Texas
| | - Mark S Link
- Department of Cardiology, UT Southwestern Medical Center, Dallas, Texas
| | - Jose A Joglar
- Department of Cardiology, UT Southwestern Medical Center, Dallas, Texas
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20
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Percutaneous left ventricular assist device
vs
. intra‐aortic balloon pump in patients with severe left ventricular dysfunction undergoing cardiovascular intervention: A meta‐analysis. Chronic Dis Transl Med 2018; 4:260-267. [PMID: 30603744 PMCID: PMC6308918 DOI: 10.1016/j.cdtm.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Indexed: 11/24/2022] Open
Abstract
Objective Although controversial, the intra-aortic balloon pump (IABP) and percutaneous left ventricular assist device (PLVAD) are widely used for initial hemodynamic stabilization. We performed a meta-analysis to compare the clinical outcomes of these two devices in patients with severe left ventricular (LV) dysfunction undergoing percutaneous coronary intervention (PCI) or ventricular tachycardia (VT) ablation. Methods MEDLINE, EMBASE, the Cochrane Registry of Controlled Trials, and reference lists of relevant articles were searched. We included randomized controlled trials (RCTs) and prospective observational studies. Meta-analysis was conducted using a random effects model. Results The quantitative analysis included 4 RCTs and 2 observational studies. A total of 348 patients received PLVAD and 340 received IABP. Meta-analysis revealed that early mortality rates (in-hospital or 30-day) did not differ between the PLVAD and IABP groups (relative risk (RR) = 1.03, 95% confidence interval (CI) = 0.70–1.51, P = 0.89). Significant differences were observed between the two groups in the composite, in-hospital, non-major adverse cardiac and cerebrovascular events (MACCE) rate (RR = 1.30, 95% CI = 1.01–1.68, P = 0.04). Conclusions Compared with IABP, PLVAD with active circulatory support did not improve early survival in those with severe left ventricular dysfunction undergoing either PCI or VT ablation, but increased the in-hospital non-MACCE rate.
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21
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Turagam MK, Vuddanda V, Koerber S, Garg J, Yarlagadda B, Dar T, Aryana A, Di Biase L, Natale A, Lakkireddy D. Percutaneous ventricular assist device in ventricular tachycardia ablation: a systematic review and meta-analysis. J Interv Card Electrophysiol 2018; 55:197-205. [PMID: 30377926 DOI: 10.1007/s10840-018-0477-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 10/16/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is a lack of compelling data regarding the benefit of percutaneous ventricular assist devices (PVAD) in patients undergoing ventricular tachycardia (VT) ablation. The study aims to conduct a meta-analysis comparing the safety and efficacy of PVAD versus no-PVAD (N-PVAD) during VT ablation. METHODS Studies meeting criteria were systematically reviewed. Baseline characteristics and clinical outcomes were extracted and analyzed. A meta-analysis was performed using random-effects model to calculate risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI). RESULTS The meta-analysis included five retrospective, observational studies consisting of 2026 patients (PVAD group-284 patients versus N-PVAD group-1742 patients). The PVAD group was sicker with significantly higher VT storm, lower LVEF and greater proportion of NYHA class ≥ III than N-PVAD (p < 0.050). The acute procedural success [RR 0.95, 95% CI, (0.89-1.00), p = 0.070], VT recurrence [RR 0.94, 95% CI, (0.66-1.34), p = 0.740] and mortality [RR 1.28, 95% CI, (0.43-3.83), p = 0.660] were similar on follow-up between PVAD versus N-PVAD. PVAD group also had significantly higher complications [RR 1.83, 95% CI (1.21-2.76), p = 0.004] and longer fluoroscopy [MD + 7.31 min, 95% CI (0.91-13.71), p = 0.030] and procedure time [MD + 71.41 min, 95% CI (31.67-111.14), p < 0.001] than N-PVAD. CONCLUSION Patients receiving PVAD support during VT ablation were sicker with no significant difference in acute procedural success, VT recurrence, and mortality compared with N-PVAD. PVAD support was also associated with higher complications and longer fluoroscopy and procedure time. A prospective randomized controlled trial will identify if using PVAD support in unstable patients undergoing VT ablation will impact clinical outcomes.
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Affiliation(s)
| | | | - Scott Koerber
- Medical University of South Carolina, Charleston, SC, USA
| | - Jalaj Garg
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bharath Yarlagadda
- Kansas City Heart Rhythm Institute & Research Foundation, Overland Park, KS, 66221, USA
| | - Tawseef Dar
- Kansas City Heart Rhythm Institute & Research Foundation, Overland Park, KS, 66221, USA
| | - Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, CA, USA
| | | | | | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute & Research Foundation, Overland Park, KS, 66221, USA.
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22
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Mechanical Circulatory Support During Catheter Ablation of Ventricular Tachycardia: Indications and Options. Heart Lung Circ 2018; 28:134-145. [PMID: 30355468 DOI: 10.1016/j.hlc.2018.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 10/02/2018] [Indexed: 01/29/2023]
Abstract
Mapping of scar-related ventricular tachycardia (VT) in structural heart disease is fundamentally driven by identifying the critical isthmus of conduction that supports re-entry in and around myocardial scar. Mapping can be performed using activation and entrainment techniques during VT, or by substrate mapping performed in stable sinus or paced rhythm. Activation and entrainment mapping requires the patient to be in continuous VT, which may not be haemodynamically tolerated, or, if tolerated, may lead to adverse sequelae related to impaired end organ perfusion. Mechanical circulatory support (MCS) devices may facilitate haemodynamic stability and preserve end organ perfusion during sustained VT to permit mapping for long periods. Available options for haemodynamic support include an intra-aortic balloon pump (IABP), TandemHeart left atrial to femoral artery bypass system (CardiacAssist Inc., Pittsburgh, PA, USA), Impella left ventricle (LV) to aorta flow-assist system (Abiomed, Danvers, MA, USA), and extracorporeal membrane oxygenation (ECMO); the bypass and assist devices provide far better augmentation of cardiac output than IABP. MCS has potential key advantages including maintenance of vital organ perfusion, reduction of intra-cardiac filling pressures, reduction of LV volumes, wall stress, and myocardial consumption of oxygen, and improvement of coronary perfusion during prolonged periods of VT induction and/or mapping. Observational studies show MCS allows for longer duration of mapping, and increased likelihood of VT termination, without an increased risk of peri-procedural mortality or VT recurrence in follow-up, despite being used in a significantly sicker cohort of patients. However, MCS has increased risk of complications related to vascular access, bleeding, thromboembolic risk, mapping system interference, increase procedural complexity and increased cost. Acute haemodynamic decompensation occurs in ∼11% of patients undergoing VT ablation, and is associated with increased mortality. Prospectively identifying patients at risk of acute haemodynamic decompensation in the peri-procedural period may allow prophylactic MCS. Although observational studies of MCS in patients at high risk of haemodynamic decompensation are encouraging, its benefit needs to be proven in randomised trials. This review will summarise the indication for MCS, forms of MCS, procedural outcomes, complications and utility of MCS during VT ablation.
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23
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Turagam MK, Vuddanda V, Atkins D, Santangeli P, Frankel DS, Tung R, Vaseghi M, Sauer WH, Tzou W, Mathuria N, Nakahara S, Dickfeld TM, Bunch TJ, Weiss P, Di Biase L, Tholakanahalli V, Vakil K, Tedrow UB, Stevenson WG, Della Bella P, Shivkumar K, Marchlinski FE, Callans DJ, Natale A, Reddy M, Lakkireddy D. Hemodynamic Support in Ventricular Tachycardia Ablation: An International VT Ablation Center Collaborative Group Study. JACC Clin Electrophysiol 2017; 3:1534-1543. [PMID: 29759835 DOI: 10.1016/j.jacep.2017.07.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/23/2017] [Accepted: 07/06/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study sought to evaluate the clinical outcomes of patients receiving hemodynamic support (HS) during ventricular tacchycardia (VT) ablation. BACKGROUND There are limited real-world data evaluating its effect of HS in ablation outcomes. METHODS An analysis of 1,655 patients from the International VT Ablation Center Collaborative group was performed. A total of 105 patients received HS with percutaneous ventricular assist device. RESULTS Patients in the HS group had lower left ventricular ejection fraction (LVEF), higher New York Heart Association (NYHA) functional class, and more implantable cardioverter-defibrillator (ICD) shocks, VT storm, and antiarrhythmic drug use (all p < 0.05). The HS group also required significantly longer fluoroscopy, procedure, and total lesion time. Acute procedural success (71.8% vs. 73.7%; p = 0.04) was significantly lower and complications (12.5% vs. 6.5%; p = 0.03) and 1-year mortality (34.7% vs. 9.3%; p < 0.001) were significantly higher in the HS group. Multivariate Cox regression analysis demonstrated HS as an independent predictor of mortality (hazard ratio: 5.01; 95% confidence interval: 3.44 to 7.20; p < 0.001). There was no significant difference in VT recurrence between groups. In a subgroup analysis including LVEF ≤20% and NYHA functional class III to IV patients, acute procedural success (74.0% vs. 70.5%; p = 0.8), complications (15.6% vs. 7.8%; p = 0.2), VT recurrence (30.2% vs. 38.1%; p = 0.44), and 1-year mortality (40.0% vs. 28.8%; p = 0.2) were no different between the HS and no-HS groups. CONCLUSIONS Patients requiring HS were sicker with multiple comorbidities and, as expected, had a significantly higher 1-year mortality than did those patients in the no-HS group. In patients with LVEF ≤20% and NYHA functional class III to IV, there was also no significant difference in clinical outcomes when compared with no HS. Further studies are needed to systematically evaluate patients undergoing VT ablation receiving HS.
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Affiliation(s)
- Mohit K Turagam
- Division of Cardiovascular Medicine, University of Missouri Hospital and Clinics, Columbia, Missouri
| | - Venkat Vuddanda
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
| | - Donita Atkins
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
| | - Pasquale Santangeli
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roderick Tung
- Pritzker School of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
| | | | - Wendy Tzou
- University of Colorado, Aurora, Colorado
| | - Nilesh Mathuria
- St. Luke's Health System/Texas Heart Institute and University of Texas Health Science Center, Houston, Texas
| | - Shiro Nakahara
- Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | | | - T Jared Bunch
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Peter Weiss
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Albert Einstein College of Medicine at Montefiore Hospital, New York, New York
| | - Venkat Tholakanahalli
- University of Minnesota Medical Center, Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - Kairav Vakil
- University of Minnesota Medical Center, Minneapolis VA Medical Center, Minneapolis, Minnesota
| | | | | | | | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
| | - Francis E Marchlinski
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Callans
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Madhu Reddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
| | - Dhanunjaya Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
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24
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Romero J, Di Biase L. Percutaneous ventricular assist devices for catheter ablation of ventricular tachycardia in structural heart disease: "A Conditio Sine Qua Non"? J Cardiovasc Electrophysiol 2017; 28:1303-1305. [PMID: 28884931 DOI: 10.1111/jce.13335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 08/31/2017] [Accepted: 09/05/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Jorge Romero
- Division of Cardiology at Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Luigi Di Biase
- Division of Cardiology at Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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25
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Aryana A, d'Avila A, Cool CL, Miller MA, Garcia FC, Supple GE, Dukkipati SR, Lakkireddy D, Bunch TJ, Bowers MR, O'Neill PG, Reddy VY, Marchlinski FE. Outcomes of catheter ablation of ventricular tachycardia with mechanical hemodynamic support: An analysis of the Medicare database. J Cardiovasc Electrophysiol 2017; 28:1295-1302. [DOI: 10.1111/jce.13312] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 06/27/2017] [Accepted: 07/21/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute; Sacramento CA USA
| | - André d'Avila
- Instituto de Pesquisa em Arritmia Cardiaca; Hospital Cardiologico-Florianópolis; Florianópolis Santa Catarina Brazil
| | | | - Marc A. Miller
- Helmsley Electrophysiology Center; Mount Sinai School of Medicine; New York NY USA
| | - Fermin C. Garcia
- Division of Cardiology; Section of Electrophysiology; University of Pennsylvania Health System and School of Medicine; Philadelphia PA USA
| | - Gregory E. Supple
- Division of Cardiology; Section of Electrophysiology; University of Pennsylvania Health System and School of Medicine; Philadelphia PA USA
| | | | - Dhanunjaya Lakkireddy
- Bloch Heart Rhythm Center; KU Cardiovascular Research Institute; University of Kansas Hospital; Kansas City KS USA
| | - T. Jared Bunch
- Intermountain Heart Institute; Intermountain Medical Center; Murray UT USA
| | - Mark R. Bowers
- Mercy General Hospital and Dignity Health Heart and Vascular Institute; Sacramento CA USA
| | | | - Vivek Y. Reddy
- Helmsley Electrophysiology Center; Mount Sinai School of Medicine; New York NY USA
| | - Francis E. Marchlinski
- Division of Cardiology; Section of Electrophysiology; University of Pennsylvania Health System and School of Medicine; Philadelphia PA USA
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26
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Kusa S, Miller MA, Whang W, Enomoto Y, Panizo JG, Iwasawa J, Choudry S, Pinney S, Gomes A, Langan N, Koruth JS, d’Avila A, Reddy VY, Dukkipati SR. Outcomes of Ventricular Tachycardia Ablation Using Percutaneous Left Ventricular Assist Devices. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004717. [DOI: 10.1161/circep.116.004717] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 04/28/2017] [Indexed: 01/22/2023]
Abstract
Background—
Although percutaneous left ventricular assist devices (pLVADs) facilitate mapping and ablation of hemodynamically unstable ventricular tachycardia (VT), there is limited data whether clinical outcomes are improved. We sought to retrospectively compare the outcomes of patients undergoing scar-related VT ablation with and without pLVAD support.
Methods and Results—
The study population comprised 194 patients (109 pLVAD and 85 non-pLVAD). The pLVAD group more often had dilated cardiomyopathy (33% versus 13%;
P
=0.001), New York Heart Association heart failure class ≥III (51% versus 25%;
P
<0.001), lower left ventricular ejection fractions (26±10% versus 39±16%;
P
<0.001), and electrical storm (49% versus 34%;
P
=0.04). Procedure times (422±112 versus 330±92 minutes;
P
<0.001), postablation VT inducibility (20% versus 7%;
P
=0.02), and length of subsequent hospitalization (median 6 versus 4 days;
P
=0.001) were all higher in the pLVAD group. During median follow-up of 215 days, the primary end point (recurrent VT, heart transplantation, or death) occurred in 36% of the pLVAD versus 26% of the non-pLVAD groups (
P
=0.14). After propensity matching for differences between groups, no differences were seen between groups for both acute procedural outcomes and the primary end point.
Conclusions—
In this large single-center scar-related VT ablation experience, despite the worse clinical status of the patients selected for pLVAD support, clinical outcomes were better than expected and were similar to healthier patients not receiving hemodynamic support. Patients with dilated cardiomyopathy presenting with electrical storm, advanced heart failure, and severe left ventricular dysfunction most frequently received hemodynamic support during VT ablation.
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Affiliation(s)
- Shigeki Kusa
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Marc A. Miller
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - William Whang
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Yoshinari Enomoto
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Jorge G. Panizo
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Jin Iwasawa
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Subbarao Choudry
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Sean Pinney
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Anthony Gomes
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Noelle Langan
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Jacob S. Koruth
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Andre d’Avila
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Vivek Y. Reddy
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
| | - Srinivas R. Dukkipati
- From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca–Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.)
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Briceño DF, Romero J, Villablanca PA, Londoño A, Diaz JC, Maraj I, Batul SA, Madan N, Patel J, Jagannath A, Mohanty S, Mohanty P, Gianni C, Della Rocca D, Sabri A, Kim SG, Natale A, Di Biase L. Long-term outcomes of different ablation strategies for ventricular tachycardia in patients with structural heart disease: systematic review and meta-analysis. Europace 2017; 20:104-115. [DOI: 10.1093/europace/eux109] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/07/2017] [Indexed: 11/14/2022] Open
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Palaniswamy C, Miller MA, Reddy VY, Dukkipati SR. Hemodynamic Support for Ventricular Tachycardia Ablation. Card Electrophysiol Clin 2017; 9:141-152. [PMID: 28167082 DOI: 10.1016/j.ccep.2016.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This review discusses the role of hemodynamic support for catheter ablation of unstable ventricular tachycardia, using commercially available mechanical circulatory support devices (intra-aortic balloon pump, Impella, TandemHeart, extracorporeal membrane oxygenation) and analyzes the published clinical experience of the safety and efficacy of these devices during ventricular tachycardia ablation. Appropriate selection of patients, device-specific characteristics, and hemodynamic monitoring is also discussed.
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Affiliation(s)
- Chandrasekar Palaniswamy
- Division of Cardiology, Department of Medicine, University of California San Francisco Fresno Medical Education Program, 155 N Fresno Street, Fresno, CA 93701, USA
| | - Marc A Miller
- Helmsley Electrophysiology Center, Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
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29
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Ahn J, Kim DH, Roh SY, Lee KN, Lee DI, Shim J, Choi JI, Kim YH. The Role of Intravenous Dopamine on Hemodynamic Support during Radiofrequency Catheter Ablation of Poorly Tolerated Idiopathic Ventricular Tachycardia. Korean Circ J 2017; 47:65-71. [PMID: 28154593 PMCID: PMC5287189 DOI: 10.4070/kcj.2016.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/25/2016] [Accepted: 06/21/2016] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives Hemodynamically unstable idiopathic ventricular tachycardias (VTs) are a challenge for activation or entrainment mapping technique. Mechanical circulatory support is an option, but is not always readily available. In this study, we investigated the safety and efficacy of hemodynamic support using intravenous (IV) dopamine solely during radiofrequency catheter ablation (RFCA) of hemodynamically unstable VT. Subjects and Methods Seven out of 86 patients with hemodynamically unstable idiopathic VT underwent de novo RFCA using dopamine in our single center. They were included in the study and reviewed retrospectively to investigate the procedural characteristics and outcomes. Results All patients were male, and the mean age was 50.7±5.3 years. One patient had implantable cardioverter-defibrillator for the secondary prevention. No evidence of myocardial ischemia was found in all patients. During the procedure, the mean blood pressure during VT without dopamine was 52.3±4.1 mmHg and increased to 82.6±3.8 mmHg after administering dopamine (Δ28.8±3.2 mmHg; total average dopamine dosage was 1266.1±389.6 mcg/kg). In all patients, activation mapping was safely applied, and VTs were terminated during energy delivery. Non-inducibility of clinical VT was achieved in all cases. There was no evidence of deterioration due to hypoperfusion during the peri-procedural period. No recurrence of ventricular tachyarrhythmias was observed in any of the patients, during a median follow-up of 23.0±6.1 months. Conclusion Hemodynamic support using IV dopamine during RFCA of hemodynamically unstable idiopathic VT facilitated detailed mapping to guide successful ablation.
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Affiliation(s)
- Jinhee Ahn
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Dong-Hyeok Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Kwang No Lee
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Dae-In Lee
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
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30
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Baratto F, Pappalardo F, Oloriz T, Bisceglia C, Vergara P, Silberbauer J, Albanese N, Cireddu M, D’Angelo G, Di Prima AL, Monaco F, Paglino G, Radinovic A, Regazzoli D, Silvetti S, Trevisi N, Zangrillo A, Della Bella P. Extracorporeal Membrane Oxygenation for Hemodynamic Support of Ventricular Tachycardia Ablation. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004492. [DOI: 10.1161/circep.116.004492] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/11/2016] [Indexed: 12/11/2022]
Abstract
Background—
We report the experience in a cohort of consecutive patients receiving extracorporeal membrane oxygenation during catheter ablation of unstable ventricular tachycardia (VT) at our center.
Methods and Results—
From 2010 to 2015, extracorporeal membrane oxygenation was initiated in 64 patients (average age: 63±15 years; left ventricular ejection fraction in 27±9%; cardiogenic shock in 23%, and electrical storm in 62% of patients) undergoing 74 unstable VT catheter ablation procedures. At least one VT was terminated in 81% of procedures with baseline inducible VT, and VT noninducibility was achieved in 69%. Acute heart failure occurred in 5 patients: 3 underwent emergency heart transplantation, 1 had left ventricular assist device (LVAD) implantation, and 1 patient eventually died because of subsequent mesenteric ischemia. All other patients were discharged alive. After a median follow-up of 21 months (13–28 months), VT recurrence was 33%; overall survival was 56 out of 64 patients (88%). Extracorporeal membrane oxygenation–supported ablation was the bridge to LVAD in 6.9% and to heart transplantation in 3.5% of patients. VT recurrence was related to ablation success (after 180 days of follow up: 19% when VT was noninducible, 42% if nonclinical VT was inducible, 75% when clinical VT was inducible, and 75% in untested patients,
P
<0.001). Incidence of all-cause death, heart transplantation, and LVAD was independently related to ablation outcome (at 180 days of follow-up: 9% when noninducibility was achieved, 50% in case of inducible VT, and 75% in untested patients,
P
<0.001). At multivariable analyses, noninducibility (hazard ratio 0.198;
P
=0.001) and left ventricular ejection fraction (hazard ratio 0.916;
P
=0.008) correlated with all-cause death, LVAD, and heart transplantation.
Conclusions—
Ablation of unstable VTs can be safely supported by extracorporeal membrane oxygenation, which allows rhythm stabilization with low procedure mortality, bridging decompensated patients to permanent LVAD or heart transplantation. Successful ablation is associated with better outcomes than unsuccessful ablation.
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Affiliation(s)
- Francesca Baratto
- From the Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery (F.B., T.O., C.B., P.V., J.S., N.A., M.C., G.D., G.P., A.R., D.R., N.T., P.D.B.) and Anesthesia and Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery (F.P., A.L.D.P., F.M., S.S., A.Z.), Ospedale San Raffaele, Milan, Italy
| | - Federico Pappalardo
- From the Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery (F.B., T.O., C.B., P.V., J.S., N.A., M.C., G.D., G.P., A.R., D.R., N.T., P.D.B.) and Anesthesia and Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery (F.P., A.L.D.P., F.M., S.S., A.Z.), Ospedale San Raffaele, Milan, Italy
| | - Teresa Oloriz
- From the Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery (F.B., T.O., C.B., P.V., J.S., N.A., M.C., G.D., G.P., A.R., D.R., N.T., P.D.B.) and Anesthesia and Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery (F.P., A.L.D.P., F.M., S.S., A.Z.), Ospedale San Raffaele, Milan, Italy
| | - Caterina Bisceglia
- From the Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery (F.B., T.O., C.B., P.V., J.S., N.A., M.C., G.D., G.P., A.R., D.R., N.T., P.D.B.) and Anesthesia and Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery (F.P., A.L.D.P., F.M., S.S., A.Z.), Ospedale San Raffaele, Milan, Italy
| | - Pasquale Vergara
- From the Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery (F.B., T.O., C.B., P.V., J.S., N.A., M.C., G.D., G.P., A.R., D.R., N.T., P.D.B.) and Anesthesia and Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery (F.P., A.L.D.P., F.M., S.S., A.Z.), Ospedale San Raffaele, Milan, Italy
| | - John Silberbauer
- From the Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery (F.B., T.O., C.B., P.V., J.S., N.A., M.C., G.D., G.P., A.R., D.R., N.T., P.D.B.) and Anesthesia and Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery (F.P., A.L.D.P., F.M., S.S., A.Z.), Ospedale San Raffaele, Milan, Italy
| | - Nicolò Albanese
- From the Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery (F.B., T.O., C.B., P.V., J.S., N.A., M.C., G.D., G.P., A.R., D.R., N.T., P.D.B.) and Anesthesia and Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery (F.P., A.L.D.P., F.M., S.S., A.Z.), Ospedale San Raffaele, Milan, Italy
| | - Manuela Cireddu
- From the Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery (F.B., T.O., C.B., P.V., J.S., N.A., M.C., G.D., G.P., A.R., D.R., N.T., P.D.B.) and Anesthesia and Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery (F.P., A.L.D.P., F.M., S.S., A.Z.), Ospedale San Raffaele, Milan, Italy
| | - Giuseppe D’Angelo
- From the Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery (F.B., T.O., C.B., P.V., J.S., N.A., M.C., G.D., G.P., A.R., D.R., N.T., P.D.B.) and Anesthesia and Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery (F.P., A.L.D.P., F.M., S.S., A.Z.), Ospedale San Raffaele, Milan, Italy
| | - Ambra Licia Di Prima
- From the Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery (F.B., T.O., C.B., P.V., J.S., N.A., M.C., G.D., G.P., A.R., D.R., N.T., P.D.B.) and Anesthesia and Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery (F.P., A.L.D.P., F.M., S.S., A.Z.), Ospedale San Raffaele, Milan, Italy
| | - Fabrizio Monaco
- From the Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery (F.B., T.O., C.B., P.V., J.S., N.A., M.C., G.D., G.P., A.R., D.R., N.T., P.D.B.) and Anesthesia and Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery (F.P., A.L.D.P., F.M., S.S., A.Z.), Ospedale San Raffaele, Milan, Italy
| | - Gabriele Paglino
- From the Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery (F.B., T.O., C.B., P.V., J.S., N.A., M.C., G.D., G.P., A.R., D.R., N.T., P.D.B.) and Anesthesia and Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery (F.P., A.L.D.P., F.M., S.S., A.Z.), Ospedale San Raffaele, Milan, Italy
| | - Andrea Radinovic
- From the Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery (F.B., T.O., C.B., P.V., J.S., N.A., M.C., G.D., G.P., A.R., D.R., N.T., P.D.B.) and Anesthesia and Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery (F.P., A.L.D.P., F.M., S.S., A.Z.), Ospedale San Raffaele, Milan, Italy
| | - Damiano Regazzoli
- From the Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery (F.B., T.O., C.B., P.V., J.S., N.A., M.C., G.D., G.P., A.R., D.R., N.T., P.D.B.) and Anesthesia and Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery (F.P., A.L.D.P., F.M., S.S., A.Z.), Ospedale San Raffaele, Milan, Italy
| | - Simona Silvetti
- From the Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery (F.B., T.O., C.B., P.V., J.S., N.A., M.C., G.D., G.P., A.R., D.R., N.T., P.D.B.) and Anesthesia and Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery (F.P., A.L.D.P., F.M., S.S., A.Z.), Ospedale San Raffaele, Milan, Italy
| | - Nicola Trevisi
- From the Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery (F.B., T.O., C.B., P.V., J.S., N.A., M.C., G.D., G.P., A.R., D.R., N.T., P.D.B.) and Anesthesia and Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery (F.P., A.L.D.P., F.M., S.S., A.Z.), Ospedale San Raffaele, Milan, Italy
| | - Alberto Zangrillo
- From the Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery (F.B., T.O., C.B., P.V., J.S., N.A., M.C., G.D., G.P., A.R., D.R., N.T., P.D.B.) and Anesthesia and Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery (F.P., A.L.D.P., F.M., S.S., A.Z.), Ospedale San Raffaele, Milan, Italy
| | - Paolo Della Bella
- From the Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery (F.B., T.O., C.B., P.V., J.S., N.A., M.C., G.D., G.P., A.R., D.R., N.T., P.D.B.) and Anesthesia and Intensive Care Unit, Department of Cardiology and Cardiothoracic Surgery (F.P., A.L.D.P., F.M., S.S., A.Z.), Ospedale San Raffaele, Milan, Italy
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31
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Deng Y, Naeini PS, Razavi M, Collard CD, Tolpin DA, Anton JM. Anesthetic Management in Radiofrequency Catheter Ablation of Ventricular Tachycardia. Tex Heart Inst J 2016; 43:496-502. [PMID: 28100967 DOI: 10.14503/thij-15-5688] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Radiofrequency catheter ablation is increasingly being used to treat patients who have ventricular tachycardia, and anesthesiologists frequently manage their perioperative care. This narrative review is intended to familiarize anesthesiologists with preprocedural, intraprocedural, and postprocedural implications of this ablation. Ventricular tachycardia typically arises from structural heart disease, most often from scar tissue after myocardial infarction. Many patients thus affected will benefit from radiofrequency catheter ablation in the electrophysiology laboratory to ablate the foci of arrhythmogenesis. The pathophysiology of ventricular tachycardia is complex, as are the technical aspects of mapping and ablating these arrhythmias. Patients often have substantial comorbidities and tenuous hemodynamic status, necessitating pharmacologic and mechanical cardiopulmonary support. General anesthesia and monitored anesthesia care, when used for sedation during ablation, can lead to drug interactions and side effects in the presence of ventricular tachycardia, so anesthesiologists should also be aware of potential perioperative complications. We discuss variables that can help anesthesiologists safely guide patients through the challenges of radiofrequency catheter ablation of ventricular tachycardia.
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32
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Kumar S, Baldinger SH, Romero J, Fujii A, Mahida SN, Tedrow UB, Stevenson WG. Substrate-Based Ablation Versus Ablation Guided by Activation and Entrainment Mapping for Ventricular Tachycardia: A Systematic Review and Meta-Analysis. J Cardiovasc Electrophysiol 2016; 27:1437-1447. [PMID: 27574120 DOI: 10.1111/jce.13088] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/04/2016] [Accepted: 08/23/2016] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Substrate-based ablation for scar-related ventricular tachycardia (VT) has gained prominence: however, there is limited data comparing it to ablation guided predominantly by activation and entrainment mapping of inducible and hemodynamically tolerated VTs. We compared the acute procedural efficacy and outcomes of predominantly substrate-based ablation versus ablation guided predominantly by activation and entrainment mapping. METHODS AND RESULTS Database searches through April 2016 identified 6 eligible studies (enrolling 403 patients, with 1 randomized study) comparing the 2 strategies. The relative risk of VT recurrence at follow-up was assessed as the primary outcome using a random-effects meta-analysis. Secondary endpoints of acute success (based on noninducibility of VT), procedural complications, and mortality were assessed using weighted mean difference with the random effects model. At a median follow-up of 18 months, the relative risk (RR) of VT recurrence was not significantly different with substrate-based versus activation/entrainment guided VT ablation (0.72, 95% confidence interval [CI] 0.44-1.18), P = 0.2). Acute success (RR 1.02, 95% CI 0.95-1.1, P = 0.6), procedural complications (RR 0.8, 95% CI 0.35-1.82, P = 0.5) cardiovascular mortality and total mortality did not differ significantly (RR 0.83, 95% CI 0.38-1.79, P = 0.6 and RR 0.76, 95% CI 0.36-1.59, P = 0.5, respectively). CONCLUSIONS This meta-analysis demonstrates similar acute procedural efficacy, and complications, VT recurrence and mortality rates when comparing a predominantly substrate-based ablation strategy to a strategy guided predominantly by activation and entrainment mapping of inducible and hemodynamically tolerated VTs.
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Affiliation(s)
- Saurabh Kumar
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Jorge Romero
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Akira Fujii
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Saagar N Mahida
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Usha B Tedrow
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - William G Stevenson
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Mathuria N, Wu G, Rojas-Delgado F, Shuraih M, Razavi M, Civitello A, Simpson L, Silva G, Wang S, Elayda M, Kantharia B, Singh S, Frazier OH, Cheng J. Outcomes of pre-emptive and rescue use of percutaneous left ventricular assist device in patients with structural heart disease undergoing catheter ablation of ventricular tachycardia. J Interv Card Electrophysiol 2016; 48:27-34. [PMID: 27497847 DOI: 10.1007/s10840-016-0168-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 07/25/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE Patient selection and timing of percutaneous left ventricular assist device (pLVAD) insertion for maximal benefit during ventricular tachycardia (VT) ablation is not well defined. We aimed to assess the outcomes of pre-emptive and rescue use of pLVAD during VT ablation in patients with ischemic and non-ischemic cardiomyopathy. METHODS Between January 2009 and October 2011, 93 patients underwent VT ablation. Three groups were compared: (1) Rescue group (n = 12)-patients who required emergent pLVAD insertion due to hemodynamic collapse during VT ablation, (2) Pre-emptive group (n = 24)-patients who had pre-ablation pLVAD insertion, and (3) Non-pLVAD group (n = 57)-patients who did not undergo pLVAD insertion. Procedural outcomes including 30-day mortality were compared. RESULTS Thirty-day mortality was higher in the Rescue group compared to the Pre-emptive group (58 vs. 4 %, p = 0.003) and non-pLVAD (58 vs. 3 %, p = 0.001) group. There was no significant difference in 30-day mortality or long-term freedom of VT between the pre-emptive and non-pLVAD groups. CONCLUSIONS Despite rescue pLVAD insertion, hemodynamic collapse during VT ablation is associated with a persistently high 30-day mortality. Further studies are warranted to predict hemodynamic collapse and to refine the role of pLVAD in this setting.
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Affiliation(s)
- Nilesh Mathuria
- Division of Cardiology, Baylor St. Luke's Medical Center/Texas Heart Institute, PO Box 20345, Houston, TX, 77225-0345, USA.
| | - Geru Wu
- Division of Cardiology, Baylor St. Luke's Medical Center/Texas Heart Institute, PO Box 20345, Houston, TX, 77225-0345, USA
| | - Francia Rojas-Delgado
- Division of Cardiology, Baylor St. Luke's Medical Center/Texas Heart Institute, PO Box 20345, Houston, TX, 77225-0345, USA
| | - Mossaab Shuraih
- Division of Cardiology, Baylor St. Luke's Medical Center/Texas Heart Institute, PO Box 20345, Houston, TX, 77225-0345, USA
| | - Mehdi Razavi
- Division of Cardiology, Baylor St. Luke's Medical Center/Texas Heart Institute, PO Box 20345, Houston, TX, 77225-0345, USA
| | - Andrew Civitello
- Division of Cardiology, Baylor St. Luke's Medical Center/Texas Heart Institute, PO Box 20345, Houston, TX, 77225-0345, USA
| | - Leo Simpson
- Division of Cardiology, Baylor St. Luke's Medical Center/Texas Heart Institute, PO Box 20345, Houston, TX, 77225-0345, USA
| | - Guilherme Silva
- Division of Cardiology, Baylor St. Luke's Medical Center/Texas Heart Institute, PO Box 20345, Houston, TX, 77225-0345, USA
| | - Suwei Wang
- Division of Biostatistics, Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, TX, USA
| | - MacArthur Elayda
- Division of Biostatistics, Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, TX, USA
| | - Bharat Kantharia
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Steve Singh
- Division of Cardiovascular Surgery, Baylor College of Medicine/Texas Heart Institute, Houston, TX, USA
| | - O H Frazier
- Division of Cardiovascular Surgery, Baylor College of Medicine/Texas Heart Institute, Houston, TX, USA
| | - Jie Cheng
- Division of Cardiology, Baylor St. Luke's Medical Center/Texas Heart Institute, PO Box 20345, Houston, TX, 77225-0345, USA
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Gorenek B, Blomström Lundqvist C, Brugada Terradellas J, Camm AJ, Hindricks G, Huber K, Kirchhof P, Kuck KH, Kudaiberdieva G, Lin T, Raviele A, Santini M, Tilz RR, Valgimigli M, Vos MA, Vrints C, Zeymer U, Kristiansen SB. Cardiac arrhythmias in acute coronary syndromes: position paper from the joint EHRA, ACCA, and EAPCI task force. EUROINTERVENTION 2015; 10:1095-108. [PMID: 25169596 DOI: 10.4244/eijy14m08_19] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Impella LD microaxial pump supporting combined mitral and coronary surgery in a patient with dilated cardiomyopathy. A short bridge to recovery? POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 12:56-9. [PMID: 26336480 PMCID: PMC4520509 DOI: 10.5114/kitp.2015.50570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 10/14/2013] [Accepted: 02/18/2014] [Indexed: 11/17/2022]
Abstract
Cardiac surgeons have to face the problem of impaired left ventricle function in patients undergoing routine valve or coronary procedures. The intra-aortic balloon pump is not always effective in preventing cardiac failure. The idea of using a microaxial rotating pump as a short-term perioperative support seems to be a convenient solution. The case of a patient with dilated cardiomyopathy undergoing combined mitral and coronary surgery with elective use of the Impella LD pump is presented. Various options of applying the Impella device are discussed, especially as a bridge to transplant or bridge to recovery.
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Gilotra NA, Stevens GR. Temporary mechanical circulatory support: a review of the options, indications, and outcomes. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 8:75-85. [PMID: 25674024 PMCID: PMC4317108 DOI: 10.4137/cmc.s15718] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 12/20/2022]
Abstract
Cardiogenic shock remains a challenging disease entity and is associated with significant morbidity and mortality. Temporary mechanical circulatory support (MCS) can be implemented in an acute setting to stabilize acutely ill patients with cardiomyopathy in a variety of clinical situations. Currently, several options exist for temporary MCS. We review the indications, contraindications, clinical applications, and evidences for a variety of temporary circulatory support options, including the intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO), CentriMag blood pump, and percutaneous ventricular assist devices (pVADs), specifically the TandemHeart and Impella.
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Affiliation(s)
- Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Gerin R Stevens
- Mechanical Circulatory Support Program, Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
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Peichl P, Wichterle D, Pavlu L, Cihak R, Aldhoon B, Kautzner J. Complications of Catheter Ablation of Ventricular Tachycardia. Circ Arrhythm Electrophysiol 2014; 7:684-90. [DOI: 10.1161/circep.114.001530] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Petr Peichl
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Dan Wichterle
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ludek Pavlu
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Robert Cihak
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Bashar Aldhoon
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Kautzner
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Aryana A, Gearoid O’Neill P, Gregory D, Scotti D, Bailey S, Brunton S, Chang M, d’Avila A. Procedural and clinical outcomes after catheter ablation of unstable ventricular tachycardia supported by a percutaneous left ventricular assist device. Heart Rhythm 2014; 11:1122-30. [DOI: 10.1016/j.hrthm.2014.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Indexed: 12/17/2022]
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Miller MA, Reddy VY. Percutaneous hemodynamic support during scar-ventricular tachycardia ablation: is the juice worth the squeeze? Circ Arrhythm Electrophysiol 2014; 7:192-4. [PMID: 24736421 DOI: 10.1161/circep.114.001590] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marc A Miller
- Helmsley Electrophysiology Center, Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY
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Vaidya VR, Desimone CV, Madhavan M, Noheria A, Shahid M, Walters J, Ladewig DJ, Mikell SB, Johnson SB, Suddendorf SH, Asirvatham SJ. Compatibility of electroanatomical mapping systems with a concurrent percutaneous axial flow ventricular assist device. J Cardiovasc Electrophysiol 2014; 25:781-6. [PMID: 24758340 DOI: 10.1111/jce.12437] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 04/15/2014] [Accepted: 04/17/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hemodynamic instability hinders activation and entrainment mapping during ventricular tachycardia ablation. The Impella 2.5 microaxial flow device (MFD; Abiomed Inc., Danvers, MA, USA) is used to prevent hemodynamic instability during electrophysiologic study. However, electromagnetic interference (EMI) generated by this device can preclude accurate electroanatomic mapping. METHODS Impella was placed in the left ventricle of 7 canines for circulatory support. Electroanatomic mapping during sinus rhythm, ventricular pacing, and ventricular fibrillation (VF) was performed using magnet- (CARTO3, Biosense Webster Inc., Diamond Bar, CA, USA) and impedance- (EnSite Velocity System/EnSite NavX, St. Jude Medical Inc., St. Paul, MN, USA) based systems. Distance from device to points with severe EMI precluding acquisition was compared to points with mild/no EMI. Two methods were used to reduce EMI: (1) titration of MFD performance, and (2) impedance-only mapping combined with manual annotation of activation. RESULTS Severe EMI did not occur during impedance-based mapping. Severe EMI was observed using CARTO3 at 9.4% of all points attempted at maximum performance level (P8) of device. Severe EMI occurred at points closer to device (40.1 ± 16.8 mm) versus (55.5 ± 20.0 mm) for mild/no EMI, P < 0.0001. Severe EMI using CARTO3 was resolved by either (1) reduction of performance from P8 to P6 or (2) impedance-only mapping with manual annotation. CONCLUSION Concurrent use of MFD caused EMI to prevent acquisition of points with magnet-based mapping. Predictors for EMI were distance from device and performance level. Temporary reductions to P6 or impedance-only mapping are 2 methods to resolve EMI.
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Affiliation(s)
- Vaibhav R Vaidya
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Reddy YM, Chinitz L, Mansour M, Bunch TJ, Mahapatra S, Swarup V, Di Biase L, Bommana S, Atkins D, Tung R, Shivkumar K, Burkhardt JD, Ruskin J, Natale A, Lakkireddy D. Percutaneous left ventricular assist devices in ventricular tachycardia ablation: multicenter experience. Circ Arrhythm Electrophysiol 2014; 7:244-50. [PMID: 24532564 DOI: 10.1161/circep.113.000548] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data on relative safety, efficacy, and role of different percutaneous left ventricular assist devices for hemodynamic support during the ventricular tachycardia (VT) ablation procedure are limited. METHODS AND RESULTS We performed a multicenter, observational study from a prospective registry including all consecutive patients (N=66) undergoing VT ablation with a percutaneous left ventricular assist devices in 6 centers in the United States. Patients with intra-aortic balloon pump (IABP group; N=22) were compared with patients with either an Impella or a TandemHeart device (non-IABP group; N=44). There were no significant differences in the baseline characteristics between both the groups. In non-IABP group (1) more patients could undergo entrainment/activation mapping (82% versus 59%; P=0.046), (2) more number of unstable VTs could be mapped and ablated per patient (1.05±0.78 versus 0.32±0.48; P<0.001), (3) more number of VTs could be terminated by ablation (1.59±1.0 versus 0.91±0.81; P=0.007), and (4) fewer VTs were terminated with rescue shocks (1.9±2.2 versus 3.0±1.5; P=0.049) when compared with IABP group. Complications of the procedure trended to be more in the non-IABP group when compared with those in the IABP group (32% versus 14%; P=0.143). Intermediate term outcomes (mortality and VT recurrence) during 12±5-month follow-up were not different between both groups. Left ventricular ejection fraction ≤15% was a strong and independent predictor of in-hospital mortality (53% versus 4%; P<0.001). CONCLUSIONS Impella and TandemHeart use in VT ablation facilitates extensive activation mapping of several unstable VTs and requires fewer rescue shocks during the procedure when compared with using IABP.
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Affiliation(s)
- Yeruva Madhu Reddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS
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Ling Z, Hari A, Tandri H. VT ablation: New Developments and Approaches. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:297. [PMID: 24515355 DOI: 10.1007/s11936-014-0297-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OPINION STATEMENT Over the past decade, catheter ablation has emerged as an important therapeutic option for ventricular tachycardia (VT) in both patients with and without structural heart disease. In patients without structural heart disease, catheter ablation serves as sole therapy for the treatment of VT. For those with structural heart disease, VT ablation has generally been reserved for patients who experience ICD therapies, and particularly those who fail antiarrhythmic agents. With the growing number of patients with implantable devices as well as improvements in heart failure therapy resulting in improved survival among ICD patients, the overall number of patients needing therapy for VT continues to increase. The past years have witnessed significant advances in our understanding of the arrhythmic substrate in various cardiomyopathies, resulting in substrate-based approaches for targeted VT ablation. Further, the growth in better technologies and techniques for VT ablation, such as the use of percutaneous epicardial ablation, the innovation of multielectrode catheters for rapid mapping, the use of intracardiac echocardiography (ICE) for mapping unusual sites, and activation and entrainment mapping of previously unmappable VTs assisted by mechanical circulatory support devices, has overcome the limitations and greatly improved the success rates of catheter ablation. This review summarizes recent advances and novel approaches in both technology and techniques for catheter ablation of ventricular tachycardia.
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Affiliation(s)
- Zhiyu Ling
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
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Jung Y. Percutaneous left ventricular assist device: a systematic review. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2014. [DOI: 10.5124/jkma.2014.57.11.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Youjin Jung
- Division for New Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
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Abstract
PURPOSE OF REVIEW Drug-refractory ventricular tachycardia in the setting of structural heart disease results in frequent implantable cardioverter defibrillator therapies and an increased risk of heart failure. Management requires catheter ablation procedures for effective suppression of the arrhythmia. RECENT FINDINGS Imaging and electroanatomic mapping technologies provide new insights into the myocardial structural abnormalities responsible for ventricular tachycardia. Integration of imaging data with three-dimensional mapping systems coupled with improved targeting of abnormal electrical signals may improve the ablation outcomes. New ablation tools show promise for the effective ablation of previously unreachable myocardial ventricular tachycardia circuits. SUMMARY Catheter ablation procedures have evolved over the last 2 decades. Improved technology may contribute to more widespread utilization of catheter ablation in the future.
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Lü F, Eckman PM, Liao KK, Apostolidou I, John R, Chen T, Das GS, Francis GS, Lei H, Trohman RG, Benditt DG. Catheter ablation of hemodynamically unstable ventricular tachycardia with mechanical circulatory support. Int J Cardiol 2013; 168:3859-65. [DOI: 10.1016/j.ijcard.2013.06.035] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 04/26/2013] [Accepted: 06/21/2013] [Indexed: 12/17/2022]
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Carbucicchio C, Ahmad Raja N, Di Biase L, Volpe V, Dello Russo A, Trivedi C, Bartoletti S, Zucchetti M, Casella M, Russo E, Santangeli P, Moltrasio M, Tundo F, Fassini G, Natale A, Tondo C. High-density substrate-guided ventricular tachycardia ablation: role of activation mapping in an attempt to improve procedural effectiveness. Heart Rhythm 2013; 10:1850-8. [PMID: 24055940 DOI: 10.1016/j.hrthm.2013.09.059] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Indexed: 01/29/2023]
Abstract
BACKGROUND Advanced techniques of electroanatomical mapping efficiently guide ventricular tachycardia (VT) ablation strategies; in this context, the adjunctive value of combining activation mapping (AMap) to improve accuracy has not been elucidated. OBJECTIVE To investigate whether conventional AMap further contributes to the identification of critical sites of VT reentry and whether this translates into a more effective ablation outcome in a cohort of patients undergoing VT ablation. METHODS We prospectively enrolled 126 patients (mean age 65.3 ± 10.5 years; left ventricular ejection fraction 33.3% ± 7.2%) with ischemic (n = 89) or idiopathic (n = 37) dilated cardiomyopathy undergoing endocardial (n = 105) or endo-epicardial (n = 21) electroanatomical mapping and ablation. A substrate-guided strategy targeting surrogate markers of reentry was accomplished in all patients, but the feasibility and efficacy of AMap was preliminarily assessed for all induced VTs focusing on early VT suppression obtained during radiofrequency delivery. VT-free survival was assessed by ICD interrogation. RESULTS AMap successfully guided ablation in 62 of 104 (59.6%) patients with inducible VT(s). At 1 year, 6 of 126 (4.8%) patients died; VT recurred in 28 of 126 (22.2%) patients. No significant difference in VT recurrence rate was observed between patients in whom AMap proved effective versus those in whom substrate-guided ablation was not corroborated by AMap (16 of 62 [25.8%] vs 12 of 64 [18.8%]; log-rank test, P = .3). CONCLUSIONS Our findings support the efficacy of a substrate-guided strategy targeting specific markers of arrhythmogenicity identified during sinus rhythm. AMap proves highly efficient acutely but does not improve overall VT-free survival, suggesting that in patients with advanced cardiac disease, life-threatening arrhythmias can be successfully treated by ablation in sinus rhythm, thus limiting procedural risks.
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Affiliation(s)
- Corrado Carbucicchio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
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Current World Literature. Curr Opin Cardiol 2013; 28:369-79. [DOI: 10.1097/hco.0b013e328360f5be] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mao H, Giuliani A, Blanca-Martos L, Kim JC, Nayak A, Virzi G, Brocca A, Scalzotto E, Neri M, Katz N, Ronco C. Effect of Percutaneous Ventricular Assist Devices on Renal Function. Blood Purif 2013; 35:119-26. [DOI: 10.1159/000346096] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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