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

  • Nilesh Mathuria
  • Geru Wu
  • Francia Rojas-Delgado
  • Mossaab Shuraih
  • Mehdi Razavi
  • Andrew Civitello
  • Leo Simpson
  • Guilherme Silva
  • Suwei Wang
  • MacArthur Elayda
  • Bharat Kantharia
  • Steve Singh
  • O. H. Frazier
  • Jie Cheng
Article
First Online:
Received:
Accepted:

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.

Keywords

Percutaneous left ventricular assist device Ventricular tachycardia Ablation Cardiomyopathy 

Abbreviations

CABG

Coronary artery bypass grafting

ECMO

Extra corporeal mechanical oxygenation

LAP

Left atrial pressure

LVEDD

Left ventricular end diastolic dimension

LVEDP

Left ventricular end diastolic pressure

LVEF

Left ventricular ejection fraction

MAP

Mean arterial pressure

NYHA

New York Heart Association

VT

Ventricular tachycardia

pLVAD

Percutaneous left ventricular assist device

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Notes

Compliance with ethical standard

Conflict of interest

None

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Nilesh Mathuria
    • 1
  • Geru Wu
    • 1
  • Francia Rojas-Delgado
    • 1
  • Mossaab Shuraih
    • 1
  • Mehdi Razavi
    • 1
  • Andrew Civitello
    • 1
  • Leo Simpson
    • 1
  • Guilherme Silva
    • 1
  • Suwei Wang
    • 2
  • MacArthur Elayda
    • 2
  • Bharat Kantharia
    • 3
  • Steve Singh
    • 4
  • O. H. Frazier
    • 4
  • Jie Cheng
    • 1
  1. 1.Division of CardiologyBaylor St. Luke’s Medical Center/Texas Heart InstituteHoustonUSA
  2. 2.Division of BiostatisticsBaylor St. Luke’s Medical Center/Texas Heart InstituteHoustonUSA
  3. 3.University of Texas Health Science Center at HoustonHoustonUSA
  4. 4.Division of Cardiovascular SurgeryBaylor College of Medicine/Texas Heart InstituteHoustonUSA

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