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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

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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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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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Authors and Affiliations

  1. Division of Cardiology, Baylor St. Luke’s Medical Center/Texas Heart Institute, PO Box 20345, Houston, TX, 77225-0345, USA

    Nilesh Mathuria, Geru Wu, Francia Rojas-Delgado, Mossaab Shuraih, Mehdi Razavi, Andrew Civitello, Leo Simpson, Guilherme Silva & Jie Cheng

  2. Division of Biostatistics, Baylor St. Luke’s Medical Center/Texas Heart Institute, Houston, TX, USA

    Suwei Wang & MacArthur Elayda

  3. University of Texas Health Science Center at Houston, Houston, TX, USA

    Bharat Kantharia

  4. Division of Cardiovascular Surgery, Baylor College of Medicine/Texas Heart Institute, Houston, TX, USA

    Steve Singh & O. H. Frazier

Authors
  1. Nilesh Mathuria
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  2. Geru Wu
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  3. Francia Rojas-Delgado
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  4. Mossaab Shuraih
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  5. Mehdi Razavi
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  6. Andrew Civitello
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  7. Leo Simpson
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  8. Guilherme Silva
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  9. Suwei Wang
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  11. Bharat Kantharia
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  12. Steve Singh
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  14. Jie Cheng
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Correspondence to Nilesh Mathuria.

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Mathuria, N., Wu, G., Rojas-Delgado, F. et al. 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 48, 27–34 (2017). https://doi.org/10.1007/s10840-016-0168-8

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  • DOI: https://doi.org/10.1007/s10840-016-0168-8

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