title: Percutaneous hemodynamic support with Impella 2.5 during scar-related ventricular tachycardia ablation (PERMIT 1).
abstract: BACKGROUND
  Percutaneous left ventricular assist devices (pLVADs) are increasingly being used to facilitate ablation of unstable ventricular tachycardia (VT), but the safety profile and hemodynamic benefits of these devices have not been described in a systematic, prospective manner.
  
  
  RESULTS
  Twenty patients with scar VT underwent ablation with a pLVAD. Neuromonitoring using cerebral oximetry was performed to evaluate a cerebral desaturation threshold to guide the duration of activation/entrainment mapping. The efficacy of pLVAD support was tested in a controlled manner with simulated VT. Complete procedural success was achieved in 50% (n=8) of patients, who were initially inducible for sustained VT, and partial procedural success in 37% (n=6). Using a cerebral desaturation level of 55% as a lower safety limit to guide the duration of sustained VT, 3 patients (15%) developed mild acute kidney injury (all resolved), and 1 (5%) patient developed mild cognitive dysfunction. During fast simulated VT (300 ms), cerebral desaturation to ≤55% occurred in more than half (53%) of patients tested without pLVAD support, compared with only 5% with full pLVAD support (P=0.003).
  
  
  CONCLUSIONS
  In a consecutive series of patients with severe left ventricular dysfunction, pLVAD-supported scar VT ablation was safe and feasible. During fast simulated VT, a miniaturized axial flow pump imparted a more favorable hemodynamic profile compared with pharmacological agents alone. Cerebral oximetry is a complimentary monitoring modality during scar VT ablation, and avoidance of cerebral desaturations below a threshold of 55% may safely guide the duration of mapping during unstable VT.
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY 10029, USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Miller
authors.forename: Srinivas R
authors.initials: SR
authors.lastname: Dukkipati
authors.forename: Jason S
authors.initials: JS
authors.lastname: Chinitz
authors.forename: Jacob S
authors.initials: JS
authors.lastname: Koruth
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Mittnacht
authors.forename: Craig
authors.initials: C
authors.lastname: Napolitano
authors.forename: Andre
authors.initials: A
authors.lastname: d'Avila
authors.forename: Vivek Y
authors.initials: VY
authors.lastname: Reddy
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000368:Aged; D001794:Blood Pressure; D017115:Catheter Ablation / Q000009:adverse effects; D002560:Cerebrovascular Circulation; D002921:Cicatrix / Q000150:complications* / Q000473:pathology; D003072:Cognition Disorders / Q000209:etiology; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009206:Myocardium / Q000473:pathology*; D010092:Oximetry; D011446:Prospective Studies; D011474:Prosthesis Design; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left