title: Catheter ablation of hemodynamically unstable ventricular tachycardia with mechanical circulatory support.
abstract: BACKGROUND
  Catheter ablation of hemodynamically unstable ventricular tachycardia (VT) is possible with mechanical circulatory support (MCS), little is known regarding the relative safety and efficacy of different supporting devices for such procedures.
  
  
  RESULTS
  Sixteen consecutive patients (aged 63 ± 11 years with left ventricular ejection fraction of 20 ± 9%) who underwent ablation of hemodynamically unstable VT were included in this study. Hemodynamic support included percutaneous (Impella® 2.5, n = 5) and implantable left ventricular assist devices (LVADs, n = 6) and peripheral cardiopulmonary bypass (CPB, n = 5). Except for 2 Impella cases, hemodynamic support was adequate (with consistent mean arterial pressure of > 60 mmHg) to permit sufficient activation mapping for ablation. In the Impella and CPB groups, mean time under hemodynamic support was 185 ± 86 min, and time in VT was 78 ± 36 min. Clinical VT could be terminated at least once by ablation in all patients except 1 case with Impella due to hemodynamic instability. Peri-procedural complications included hemolysis in 1 patient with Impella and surgical intervention for percutaneous Impella placement problems in another 2. The median number of appropriately delivered defibrillator therapies was significantly decreased from 6 in the month before VT ablation to 0 in the month following ablation (p = 0.001).
  
  
  CONCLUSIONS
  Our data suggest that peripheral CPB and implantable LVAD provide adequate hemodynamic support for successful ablation of unstable VT. Impella® 2.5, on the other hand, was associated with increased risk of complications, and may not provide sufficient hemodynamic support in some cases.
authors.affiliation: University of Minnesota, Minneapolis, MN, USA. Electronic address: luxxx074@umn.edu.
authors.forename: Fei
authors.initials: F
authors.lastname: Lü
authors.forename: Peter M
authors.initials: PM
authors.lastname: Eckman
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Liao
authors.forename: Ioanna
authors.initials: I
authors.lastname: Apostolidou
authors.forename: Ranjit
authors.initials: R
authors.lastname: John
authors.forename: Taibo
authors.initials: T
authors.lastname: Chen
authors.forename: Gladwin S
authors.initials: GS
authors.lastname: Das
authors.forename: Gary S
authors.initials: GS
authors.lastname: Francis
authors.forename: Han
authors.initials: H
authors.lastname: Lei
authors.forename: Richard G
authors.initials: RG
authors.lastname: Trohman
authors.forename: David G
authors.initials: DG
authors.lastname: Benditt
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*
keywords: CF-LVAD; CPB; CS; Cardiopulmonary bypass; Catheter ablation; GFR; ICD; Impella; LVAD; Left ventricular assist device; MAP; MCS; Mechanical circulatory support; Unstable ventricular tachycardia; VT; cardiopulmonary bypass; continuous flow left ventricular assist device; coronary sinus; glomerular filtration rate; implantable cardioverter defibrillator; left ventricular assist device; mean arterial pressure; mechanical circulatory support; rSO(2); regional oxygen saturation; ventricular tachycardia