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Lüsebrink E, Binzenhöfer L, Hering D, Villegas Sierra L, Schrage B, Scherer C, Speidl WS, Uribarri A, Sabate M, Noc M, Sandoval E, Erglis A, Pappalardo F, De Roeck F, Tavazzi G, Riera J, Roncon-Albuquerque R, Meder B, Luedike P, Rassaf T, Hausleiter J, Hagl C, Zimmer S, Westermann D, Combes A, Zeymer U, Massberg S, Schäfer A, Orban M, Thiele H. Scrutinizing the Role of Venoarterial Extracorporeal Membrane Oxygenation: Has Clinical Practice Outpaced the Evidence? Circulation 2024; 149:1033-1052. [PMID: 38527130 DOI: 10.1161/circulationaha.123.067087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for temporary mechanical circulatory support in various clinical scenarios has been increasing consistently, despite the lack of sufficient evidence regarding its benefit and safety from adequately powered randomized controlled trials. Although the ARREST trial (Advanced Reperfusion Strategies for Patients with Out-of-Hospital Cardiac Arrest and Refractory Ventricular Fibrillation) and a secondary analysis of the PRAGUE OHCA trial (Prague Out-of-Hospital Cardiac Arrest) provided some evidence in favor of VA-ECMO in the setting of out-of-hospital cardiac arrest, the INCEPTION trial (Early Initiation of Extracorporeal Life Support in Refractory Out-of-Hospital Cardiac Arrest) has not found a relevant improvement of short-term mortality with extracorporeal cardiopulmonary resuscitation. In addition, the results of the recently published ECLS-SHOCK trial (Extracorporeal Life Support in Cardiogenic Shock) and ECMO-CS trial (Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock) discourage the routine use of VA-ECMO in patients with infarct-related cardiogenic shock. Ongoing clinical trials (ANCHOR [Assessment of ECMO in Acute Myocardial Infarction Cardiogenic Shock, NCT04184635], REVERSE [Impella CP With VA ECMO for Cardiogenic Shock, NCT03431467], UNLOAD ECMO [Left Ventricular Unloading to Improve Outcome in Cardiogenic Shock Patients on VA-ECMO, NCT05577195], PIONEER [Hemodynamic Support With ECMO and IABP in Elective Complex High-risk PCI, NCT04045873]) may clarify the usefulness of VA-ECMO in specific patient subpopulations and the efficacy of combined mechanical circulatory support strategies. Pending further data to refine patient selection and management recommendations for VA-ECMO, it remains uncertain whether the present usage of this device improves outcomes.
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Affiliation(s)
- Enzo Lüsebrink
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Leonhard Binzenhöfer
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Daniel Hering
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Laura Villegas Sierra
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Germany and DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany (B.S.)
| | - Clemens Scherer
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Walter S Speidl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (W.S.S.)
| | - Aitor Uribarri
- Cardiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. CIBER-CV (A.U.)
| | - Manel Sabate
- Interventional Cardiology Department, Hospital Clinic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (M.S.)
| | - Marko Noc
- Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia (M.N.)
| | - Elena Sandoval
- Department of Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain (E.S.)
| | - Andrejs Erglis
- Latvian Centre of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia (A.E.)
| | - Federico Pappalardo
- Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy (F.P.)
| | - Frederic De Roeck
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium (F.D.R.)
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia Intensive Care, Fondazione IRCCS Policlinico San Matteo, Italy (G.T.)
| | - Jordi Riera
- Intensive Care Department, Vall d'Hebron University Hospital, and SODIR, Vall d'Hebron Research Institute, Barcelona, Spain (J.R.)
| | - Roberto Roncon-Albuquerque
- Department of Intensive Care Medicine, São João University Hospital Center, UnIC@RISE and Department of Surgery and Physiology, Faculty of Medicine of Porto, Portugal (R.R.-A.)
| | - Benjamin Meder
- Department of Cardiology, Angiology, and Pneumology, University Hospital Heidelberg, Germany (B.M.)
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen (P.L., T.R.)
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen (P.L., T.R.)
| | - Jörg Hausleiter
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany (C.H.)
| | - Sebastian Zimmer
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, Germany (S.Z.)
| | - Dirk Westermann
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Germany (D.W.)
| | - Alain Combes
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France, and Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, Paris, France (A.C.)
| | - Uwe Zeymer
- Klinikum der Stadt Ludwigshafen and Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany (U.Z.)
| | - Steffen Massberg
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Andreas Schäfer
- Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.)
| | - Martin Orban
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology and Leipzig Heart Science, Germany (H.T.)
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Troisi F, Guida P, Quadrini F, Di Monaco A, Vitulano N, Caruso R, Orfino R, Cecere G, Anselmino M, Grimaldi M. Zero Fluoroscopy Arrhythmias Catheter Ablation: A Trend Toward More Frequent Practice in a High-Volume Center. Front Cardiovasc Med 2022; 9:804424. [PMID: 35571172 PMCID: PMC9095839 DOI: 10.3389/fcvm.2022.804424] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAwareness of radiation exposure risks associated to interventional cardiology procedures is growing. The availability of new technologies in electrophysiology laboratories has reduced fluoroscopy usage during arrhythmias ablations. The aim of this study was to describe procedures with and without X-Rays and to assess feasibility, safety, and short-term efficacy of zero fluoroscopy intervention in a high-volume center oriented to keep exposure to ionizing radiation as low as reasonably achievable.MethodsCardiac catheter ablations performed in our hospital since January 2017 to June 2021.ResultsA total of 1,853 procedures were performed with 1,957 arrhythmias treated. Rate of fluoroless procedures was 15.4% (285 interventions) with an increasing trend from 8.5% in 2017 to 22.9% of first semester 2021. The most frequent arrhythmia treated was atrial fibrillation (646; 3.6% fluoroless) followed by atrioventricular nodal reentrant tachycardia (644; 16.9% fluoroless), atrial flutter (215; 8.8% fluoroless), ventricular tachycardia (178; 17.4% fluoroless), premature ventricular contraction (162; 48.1% fluoroless), and accessory pathways (112; 31.3% fluoroless). Although characteristics of patients and operative details were heterogeneous among treated arrhythmias, use of fluoroscopy did not influence procedure duration. Moreover, feasibility and efficacy were 100% in fluoroless ablations while the rate of major complications was very low and no different with or without fluoroscopy (0.45 vs. 0.35%).ConclusionLimiting the use of X-Rays is necessary, especially when the available technologies allow a zero-use approach. A lower radiation exposure may be reached, reducing fluoroscopy usage whenever possible during cardiac ablation procedures with high safety, full feasibility, and efficacy.
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Affiliation(s)
- Federica Troisi
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
- *Correspondence: Federica Troisi
| | - Pietro Guida
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
| | - Federico Quadrini
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
| | - Antonio Di Monaco
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Nicola Vitulano
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
| | - Rosa Caruso
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
| | - Rocco Orfino
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
| | - Giacomo Cecere
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, Italy
| | - Massimo Grimaldi
- Cardiology Department, Regional General Hospital “F. Miulli”, Bari, Italy
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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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4
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Monaco F, Ajello S, Calabrò MG, Melisurgo G, Landoni G, Arata A, Lerose CC, Fumagalli E, Tomasso ND, Frontera A, Scandroglio AM, Della Bella P, Zangrillo A. Left Ventricular Unloading With an IABP in Patients Undergoing Ventricular Tachycardia Ablation With ECMO Support. J Cardiothorac Vasc Anesth 2021; 35:2686-2693. [PMID: 33487532 DOI: 10.1053/j.jvca.2020.12.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The authors investigated the preprocedural predictors of postprocedural intra-aortic balloon pump (IABP) need in patients undergoing transcatheter ventricular tachycardia (VT) ablation on venoarterial (VA) extracorporeal membrane oxygenation (ECMO). DESIGN Observational study. SETTING Hybrid operating room and intensive care unit of a teaching hospital. PATIENTS Participants were 121 consecutive patients with unstable VT undergoing transcatheter ablation with VA-ECMO. INTERVENTIONS In patients with postprocedural echocardiographic, radiographic, or hemodynamic signs of increased left ventricle afterload, an IABP was positioned. MEASUREMENTS AND MAIN RESULTS Patients in the IABP group were more frequently on angiotensin-converting enzyme inhibitors (58% v 37%; p = 0.03) and had lower median baseline ejection fraction (25% v 28% p = 0.05), larger end-diastolic diameter (69.7 mm ± 13.0 v 65.7 mm ± 11.3; p = 0.03), and more frequent ischemic etiology as the reason for dilated cardiomyopathy (76% v 47%; p = 0.04,) when compared with patients not requiring IABP. Postoperatively, the IABP group required longer mechanical ventilation (24 hours [20-56.5] v 23 hours [15-28]; p = 0.003), intensive care unit stay (78 hours [46-174] v 48 hours [24-72]; p < 0.001), and continuous renal replacement therapy (13.3% v 1.3%; p = 0.006). By multivariate analysis, end-diastolic diameter (odds ratio [OR]:1.08; confidence interval [CI]: 1.00-1.16; p = 0.049), ischemic dilated cardiomyopathy (OR: 8.40; CI: 2.15-32.88; p = 0.002), and more-than-moderate mitral regurgitation (OR: 4.83; CI: 1.22-19.22; p = 0.025) were independent predictors of need for IABP. CONCLUSIONS The need for an IABP to unload the left ventricle can be predicted by ventricular size, medium-severe mitral valvular defect, and ischemic etiology of the dilated cardiomyopathy.
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Affiliation(s)
- Fabrizio Monaco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU
| | - Silvia Ajello
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU
| | - Maria Grazia Calabrò
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU
| | - Giulio Melisurgo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Allegra Arata
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU
| | - Caterina Cecilia Lerose
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU
| | - Elisabetta Fumagalli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU
| | - Nora Di Tomasso
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU
| | - Antonio Frontera
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU
| | - Anna Mara Scandroglio
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Della Bella
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Jiménez Candil J, Castro JC, Hernández J, Fernández-Portales J, Durán M, Durán O, Pérez J, Elices J, Moríñigo JL, Martín F, González-Juanatey C, Sánchez PL. Timing of Ablation and Prognosis of Patients With Electrical Storm and Scar-Related Left Ventricular Dysfunction. Am J Cardiol 2020; 136:87-93. [PMID: 32946863 DOI: 10.1016/j.amjcard.2020.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/29/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
Although radiofrequency catheter ablation (RFCA) is indicated in electrical storm (ES) refractory to antiarrhythmic drugs, its most appropriate timing has not been determined. Our objective is to analyse the impact of the timing of RFCA on 30-day mortality in patients with ES and previous scar-related systolic dysfunction. In this multi-centre study, we analysed 104 patients (age: 72 ± 10, left ventricular ejection fraction: 30 ± 6%) attended consecutively due to an ES caused by monomorphic ventricular tachycardia. Sixty-four subjects were treated with RFCA (mean time from admission = 83 ± 67 hours) and 40 were not. Upon admission 25 (24%) individuals had severe heart failure. Mortality rate at 30 days was 24 (23%) patients. RFCA was associated with a reduction of 30-day mortality (hazard ratio = 0.2; p = 0.008). After showing a positive correlation between the time of the RFCA (hours) and survival at 30 days (C-statistic = 0.77; p <0.001), we found that only subjects ablated >48 hours after admission had lower mortality at 30 days than those treated conservatively: 38% (no RFCA) versus 30% (RFCA ≤48 hours) versus 7% (RFCA >48 hours) (adjusted hazard ratio for RFCA >48 hours vs others = 0.2; p = 0.007). Among the patients ablated, those who were non-inducible had lower 30-day mortality: 8% versus 29% (p = 0.03). Extracorporeal membrane oxygenation was associated with a higher rate of non-inducibility in RFCA >48 hours (100% vs 76%; p = 0.03), but not in RFCA ≤48 hours (60% vs 60%; p = 1). In conclusion, among high-risk patients with ES, RFCA performed >48 hours after admission is associated with a reduction in 30-day mortality. In such subjects, the probability of successful RFCA increases when performed under extracorporeal membrane oxygenation support.
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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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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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8
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Venoarterial Extracorporeal Membrane Oxygenation Support for Ventricular Tachycardia Ablation: A Systematic Review. ASAIO J 2020; 66:980-985. [DOI: 10.1097/mat.0000000000001125] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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