Urgent catheter ablation in Japanese patients with mechanical circulatory supports suffering from refractory ventricular electrical storm

Abstract

Background: Therapeutic strategy using catheter ablation for ventricular tachyarrhythmias (VTAs) electrical storms in patients dependent on percutaneous mechanical circulatory support (MCS) has not yet been established.

Methods: We reviewed the patients with or without requiring MCS who received urgent VTAs ablation in our institute between January 2020 and May 2022. Electrophysiological and clinical outcomes were compared between those with and without requiring MCS.

Results: Twenty procedures (16 patients, median 76 years, 13 males) were included. Six procedures using MCS underwent ablations and the other 14 procedures were performed without MCS. Although VTAs cycle lengths were not significantly different between the two groups, the incidence of hemodynamic stability was significantly higher in MCS group than in those without (83 % vs. 29 %, p = 0.024). Temporary MCS were explanted in all patients following the successful ablation, whereas the complication rates were higher in patients requiring MCS (67 % vs. 0 %, p = 0.001). Cumulative incidences of cardiovascular death and appropriate therapy of implantable cardioverter defibrillator within 90 days following the procedures were not significantly different between the two groups (p = 0.071 and p = 0.063, respectively).

Conclusion: Urgent ablation might be a feasible bail out option for those dependent on MCS suffering from VTAs, although physicians should be on high alert for device-related bleeding.

Keywords: Cardiogenic shock; Mechanical circulatory support; Percutaneous left ventricular assist device; Ventricular electrical storm.