Percutaneous left ventricular assist devices in ventricular tachycardia ablation: multicenter experience

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.

Keywords: catheter ablation; intra-aortic balloon pumping; tachycardia, ventricular.

Figure 1

Patient with an intra-aortic balloon pump (IABP) in place undergoing ventricular tachycardia ablation with Stereotaxis remote navigation system. A left anterior oblique view of the chest with the IABP balloon in the descending aorta. ICD indicates implantable cardiac defibrillator; ICE, intracardiac echocardiography; LV, left ventricle; RMT, remote magnetic technology; RV, right ventricle; and RVA, right ventricular apex.

Figure 2

Patient with an Impella in place undergoing ventricular tachycardia ablation with Stereotaxis remote navigation system. ICD indicates implantable cardiac defibrillator; ICE, intracardiac echocardiography; LV, left ventricle; RMT, remote navigation technology; and RV, right ventricle.

Figure 3

Patient with a TandemHeart device in place. A, Is a right anterior oblique fluoroscopic imaged with the intake cannula (labeled with arrows) inserted into the left atrium. B, Is an image of the corresponded transesophageal echocardiogram image with the intake cannula inserted in the left atrium and labeled for reference. CS indicates coronary sinus; and RV, right ventricle.