Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Dec;7(4):282-287.
doi: 10.15420/aer.2018.36.3.

Identifying Risk and Management of Acute Haemodynamic Decompensation During Catheter Ablation of Ventricular Tachycardia

Daniele Muser  1 , Simon A Castro  1 , Jackson J Liang  1 , Pasquale Santangeli  1
Affiliations
Review

Identifying Risk and Management of Acute Haemodynamic Decompensation During Catheter Ablation of Ventricular Tachycardia

Daniele Muser et al. Arrhythm Electrophysiol Rev. 2018 Dec.

Abstract

Radiofrequency catheter ablation (CA) has an established role in the management of patients with structural heart disease presenting with recurrent ventricular tachycardia (VT). Due to the complex underlying substrate, high burden of comorbidities and concomitant heart failure (HF) status, these patients may be at higher risk of periprocedural complications. The prolonged low-output state related to VT induction and mapping, as well as the fluid overload due to irrigated CA and the use of general anaesthesia, may decompensate the HF status, leading to multiple-organ failure and increase in early post-procedural mortality. Proper identification of patients at high risk of periprocedural acute haemodynamic decompensation (AHD) has important implications in terms of procedural planning (i.e. prophylactic use of mechanical assistance devices) and pre-procedural management in order to optimise the HF status. In the present manuscript we focus on the clinical predictors of AHD and the strategies to improve pre-procedural risk stratification, as well as the evidence supporting the use of haemodynamic support during CA procedures.

Keywords: Haemodynamic decompensation; catheter ablation; mechanical haemodynamic support; ventricular tachycardia.

PubMed Disclaimer

Conflict of interest statement

Disclosure: The authors have no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. PAINESD Risk Score
Figure 2:
Figure 2:. Summary of the Principal Studies Validating the PAINESD Scoring System
See this image and copyright information in PMC

References

    1. Liang JJ, Muser D, Santangeli P. Ventricular tachycardia ablation clinical trials. Card Electrophysiol Clin. 2017;9:153–65. doi: 10.1016/j.ccep.2016.10.012. - DOI - PubMed
    1. Santangeli P, Muser D, Maeda S et al. Comparative effectiveness of antiarrhythmic drugs and catheter ablation for the prevention of recurrent ventricular tachycardia in patients with implantable cardioverter-defibrillators: a systematic review and meta-analysis of randomized controlled trials. Heart Rhythm. 2016;13:1552–9. doi: 10.1016/j.hrthm.2016.03.004. - DOI - PubMed
    1. Liang JJ, Santangeli P, Callans DJ. Long-term outcomes of ventricular tachycardia ablation in different types of structural heart disease. Arrhythm Electrophysiol Rev. 2015;4:177–83. doi: 10.15420/aer.2015.4.3.177. - DOI - PMC - PubMed
    1. Sapp JL, Wells GA, Parkash R et al. Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs. N Engl J Med. 2016;375:111–21. doi: 10.1056/NEJMoa1513614. - DOI - PubMed
    1. Saxon LA, Bristow MR, Boehmer J et al. Predictors of sudden cardiac death and appropriate shock in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial. Circulation. 2006;114:2766–72. doi: 10.1161/CIRCULATIONAHA.106.642892. - DOI - PubMed