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. 2020 Jun 1:308:42-49.
doi: 10.1016/j.ijcard.2020.03.045. Epub 2020 Mar 19.

Mechanical circulatory support for life-threatening arrhythmia: A systematic review

Silvia Mariani  1 , L Christian Napp  2 , Valeria Lo Coco  3 , Thijs S R Delnoij  4 , Justin G L M Luermans  5 , Rachel M A Ter Bekke  5 , Carl Timmermans  5 , Tong Li  6 , Guenes Dogan  6 , Jan D Schmitto  6 , Jos Maessen  7 , Bart Maesen  3 , Roberto Lorusso  7
Affiliations

Mechanical circulatory support for life-threatening arrhythmia: A systematic review

Silvia Mariani et al. Int J Cardiol. .

Abstract

Background: The use of temporary mechanical circulatory support (tMCS) during arrhythmia is increasing, although available evidence for this indication is limited, with significant gaps of knowledge regarding appropriate timing, management and configuration. This systematic review sought to analyze the use of tMCS in patients with life-threatening arrhythmia.

Methods: A systematic literature search identified 2529 references published until September 2019. Adult and pediatric patients diagnosed with all kind of life-threatening arrhythmia were included. tMCS was primarily compared to conventional non-tMCS therapies. Primary outcome measure was in-hospital or 30-day mortality.

Results: 19 non-randomized studies were selected, including 2465 adult and 82 pediatric patients. Primary outcome in tMCS patients varied widely (4-62%) with differences based on the use of prophylactic tMCS (4-21%) or rescue tMCS (58-62%). A substantial mortality benefit was observed among high-risk patients, as identified with PAINESD risk score or suffering from electrical storm and treated with prophylactic tMCS. During ablation procedures, tMCS patients showed higher rates of induced ventricular tachycardias (VTs), ablated VTs, VT termination and non-inducibility after ablation. Extracorporeal membrane oxygenation (ECMO) was applied in pediatric cases as hemodynamic protection for aggressive antiarrhythmic medical treatment with >80% survival.

Conclusions: Prophylactic tMCS is associated with improved survival as compared to rescue or no-tMCS in patients with life-threatening arrhythmia, and may be considered in patients with high PAINESD risk score or suffering from electrical storm. ECMO can be advised as rescue and support therapy in pediatric cases requiring aggressive antiarrhythmic medical treatment.

Keywords: Arrhythmia; ECMO; Electrical storm; Extracorporeal circulation; IABP; Impella; Mechanical circulatory support; Ventricular tachycardia.

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Conflict of interest statement

Declaration of competing interest L Christian Napp: consultant, proctoring and lecture honoraria from Abiomed, lecture honoraria from Abbott and Maquet. Jan D Schmitto and Guenes Dogan: consultant for Abbott and Medtronic. Roberto Lorusso: Principal Investigator – PERSIST-AVR Study (sponsored by LivaNova); consultant LivaNova, EuroSets, Medtronic; advisory board PulseCath.

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