title: Activation and entrainment mapping of hemodynamically unstable ventricular tachycardia using a percutaneous left ventricular assist device.
abstract: OBJECTIVE
  Our goal was to investigate the effects of percutaneous left ventricular assist device (pLVAD) support during catheter ablation of unstable ventricular tachycardia (VT).
  
  
  BACKGROUND
  Mechanical cardiac support during ablation of unstable VT is being increasingly used, but there is little available information on the potential hemodynamic benefits.
  
  
  METHODS
  Twenty-three consecutive procedures in 22 patients (ischemic, n = 11) with structural heart disease and hemodynamically unstable VT were performed with either pLVAD support (n = 10) or no pLVAD support (intra-aortic balloon pump counterpulsation, n = 6; no support, n = 7). Procedural monitoring included vital signs, left atrial pressure, arterial blood pressure, cerebral perfusion/oximetry, VT characteristics, and ablation outcomes.
  
  
  RESULTS
  The pLVAD group was maintained in VT significantly longer than the non-pLVAD group (66.7 min vs. 27.5 min; p = 0.03) and required fewer early terminations of sustained VT for hemodynamic instability (1.0 vs. 4.0; p = 0.001). More patients in the pLVAD group had at least 1 VT termination during ablation than non-pLVAD patients (9 of 10 [90%] vs. 5 of 13 [38%]; p = 0.03). There were no differences between groups in duration of cerebral deoxygenation, hypotension or perioperative changes in left atrial pressure, brain natriuretic peptide levels, lactic acid, or renal function.
  
  
  CONCLUSIONS
  In patients with scar-related VT undergoing catheter ablation, pLVAD support was able to safely maintain end-organ perfusion despite extended periods of hemodynamically unstable VT. Randomized studies are necessary to determine whether this enhanced ability to perform entrainment and activation mapping will translate into a higher rate of clinical success.
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, New York, USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Miller
authors.forename: Srinivas R
authors.initials: SR
authors.lastname: Dukkipati
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Mittnacht
authors.forename: Jason S
authors.initials: JS
authors.lastname: Chinitz
authors.forename: Lynn
authors.initials: L
authors.lastname: Belliveau
authors.forename: Jacob S
authors.initials: JS
authors.lastname: Koruth
authors.forename: J Anthony
authors.initials: JA
authors.lastname: Gomes
authors.forename: Andre
authors.initials: A
authors.lastname: d'Avila
authors.forename: Vivek Y
authors.initials: VY
authors.lastname: Reddy
mesh_terms: D000368:Aged; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome