title: Efficacy and safety of ventricular tachycardia ablation with mechanical circulatory support compared with substrate-based ablation techniques.
abstract: OBJECTIVE
  Catheter ablation of ventricular tachycardia (VT) can be limited by haemodynamic instability. In these cases, substrate-based ablation is typically performed. An alternative is to perform activation and entrainment mapping during VT supported by a percutaneous left ventricular assist device (pVAD). We sought to compare the complication and success rates of pVAD-assisted VT ablation with scar-based techniques.
  
  
  RESULTS
  Thirteen consecutive patients with haemodynamically unstable VT underwent pVAD-assisted ablation (pVAD group) and were retrospectively compared with 18-matched patients undergoing a substrate-based VT ablation (non-pVAD group). There was no significant difference in age or ejection fraction between the groups although pVAD patients tended to have more shocks in the preceding months. Procedure times were longer for the pVAD group. The number of monomorphic VTs induced was greater in the pVAD group (3.2 vs. 1.6, P= 0.04); however, after ablation, there was no difference in inducibility between the pVAD and non-pVAD group (10 of 13 vs. 12 of 18; 77 vs. 67%, P = 0.69). There was no difference in acute complications including stroke or death. At 9 ± 3 months, 1-year freedom from implantable cardioverter-defibrillator (ICD) shocks/therapies for sustained VT were similar (P= 0.96). In multivariable analysis, the absence of atrial fibrillation (hazard ratio=0.15, P= 0.04) was associated with a lower incidence of ICD shocks.
  
  
  CONCLUSIONS
  In high-risk patients, pVAD-assisted VT ablation guided by activation and entrainment mapping is a feasible alternative to substrate mapping and allows outcomes comparable to substrate mapping.
authors.affiliation: Intermountain Medical Center, Salt Lake City, UT,  USA.
authors.forename: T Jared
authors.initials: TJ
authors.lastname: Bunch
authors.forename: Andy
authors.initials: A
authors.lastname: Darby
authors.forename: Heidi T
authors.initials: HT
authors.lastname: May
authors.forename: Michael
authors.initials: M
authors.lastname: Ragosta
authors.forename: D Scott
authors.initials: DS
authors.lastname: Lim
authors.forename: Angela M
authors.initials: AM
authors.lastname: Taylor
authors.forename: John P
authors.initials: JP
authors.lastname: DiMarco
authors.forename: Gorav
authors.initials: G
authors.lastname: Ailawadi
authors.forename: James R
authors.initials: JR
authors.lastname: Revenaugh
authors.forename: J Peter
authors.initials: JP
authors.lastname: Weiss
authors.forename: Srijoy
authors.initials: S
authors.lastname: Mahapatra
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D002921:Cicatrix / Q000453:epidemiology; D018572:Disease-Free Survival; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006353:Heart-Assist Devices / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome
references.citation: Circulation. 2003 Aug 12;108(6):704-10
references.pmid: 12885746
references.citation: Circulation. 1998 Jul 28;98(4):308-14
references.pmid: 9711935
references.citation: J Cardiovasc Electrophysiol. 2010 Apr;21(4):458-61
references.pmid: 20039989
references.citation: Circulation. 2004 Aug 10;110(6):652-9
references.pmid: 15289385
references.citation: Europace. 2009 Jun;11(6):771-817
references.pmid: 19443434
references.citation: Circulation. 2007 May 29;115(21):2750-60
references.pmid: 17533195
references.citation: Am J Cardiol. 1998 Aug 15;82(4):429-32
references.pmid: 9723628
references.citation: Circulation. 1993 Feb;87(2):363-72
references.pmid: 8425285
references.citation: Herz. 2009 Nov;34(7):545-52
references.pmid: 20091254
references.citation: Perfusion. 2003 Apr;18(2):79-82
references.pmid: 12868784
references.citation: J Cardiovasc Electrophysiol. 2010 Mar;21(3):339-79
references.pmid: 20082650
references.citation: N Engl J Med. 2008 Sep 4;359(10):1009-17
references.pmid: 18768944
references.citation: J Am Coll Cardiol. 2003 Jan 1;41(1):81-92
references.pmid: 12570949
references.citation: Circulation. 2000 Mar 21;101(11):1288-96
references.pmid: 10725289
references.citation: Circulation. 2001 Aug 7;104(6):664-9
references.pmid: 11489772
references.citation: J Am Coll Cardiol. 1997 May;29(6):1180-9
references.pmid: 9137211
references.citation: J Am Coll Cardiol. 2000 May;35(6):1442-9
references.pmid: 10807445
references.citation: J Cardiovasc Electrophysiol. 2000 Jan;11(1):41-4
references.pmid: 10695460
references.citation: J Cardiovasc Electrophysiol. 2007 Jan;18(1):106-9
references.pmid: 17229307
references.citation: Circ Arrhythm Electrophysiol. 2008 Aug;1(3):153-61
references.pmid: 19808409
references.citation: Heart Rhythm. 2010 May;7(5):604-9
references.pmid: 20156612
references.citation: Circulation. 1993 Oct;88(4 Pt 1):1647-70
references.pmid: 8403311