title: Procedural and clinical outcomes after catheter ablation of unstable ventricular tachycardia supported by a percutaneous left ventricular assist device.
abstract: BACKGROUND
  Hemodynamic support using percutaneous left ventricular assist devices (pLVADs) during catheter mapping and ablation of unstable ventricular tachycardia (VT) can provide effective end-organ perfusion. However, its effect on procedural and clinical outcomes remains unclear.
  
  
  OBJECTIVE
  To retrospectively evaluate the procedural and clinical outcomes after the catheter ablation of unstable VT with and without pLVAD support.
  
  
  METHODS
  Sixty-eight consecutive unstable, scar-mediated endocardial and/or epicardial VT ablation procedures performed in 63 patients were evaluated. During VT mapping and ablation, hemodynamic support was provided by intravenous inotropes with a pLVAD (n = 34) or without a pLVAD (control; n = 34).
  
  
  RESULTS
  Baseline patient characteristics were similar. VT was sustained longer with a pLVAD (27.4 ± 18.7 minutes) than without a pLVAD (5.3 ± 3.6 minutes) (P < .001). A higher number of VTs were terminated during ablation with a pLVAD (1.2 ± 0.9 per procedure) than without a pLVAD (0.4 ± 0.6 per procedure) (P < .001). Total radiofrequency ablation time was shorter with a pLVAD (53 ± 30 minutes) than without a pLVAD (68 ± 33 minutes) (P = .022), but with similar procedural success rates (71% for both pLVAD and control groups; P = 1.000). Although during 19 ± 12 months of follow-up VT recurrence did not differ between pLVAD (26%) and control (41%) groups (P = .305), the composite end point of 30-day rehospitalization, redo-VT ablation, recurrent implantable cardioverter-defibrillator therapies, and 3-month mortality was lower with a pLVAD (12%) than without a pLVAD (35%) (P = .043).
  
  
  CONCLUSIONS
  In this nonrandomized retrospective study, catheter ablation of unstable VT supported by a pLVAD was associated with shorter ablation times and reduced hospital length of stay. While pLVAD support did not affect VT recurrence, it was associated with a lower composite end point of 30-day rehospitalization, redo-VT ablation, recurrent implantable cardioverter-defibrillator therapies, and 3-month mortality.
authors.affiliation: Regional Cardiology Associates, Sacramento, California; Mercy Heart & Vascular Institute, Sacramento, California. Electronic address: aaryana@rcamd.com.
authors.forename: Arash
authors.initials: A
authors.lastname: Aryana
authors.affiliation: Regional Cardiology Associates, Sacramento, California; Mercy Heart & Vascular Institute, Sacramento, California.
authors.forename: P
authors.initials: P
authors.lastname: Gearoid O'Neill
authors.affiliation: Presscott Associates, a division of ParenteBeard, New York, New York.
authors.forename: David
authors.initials: D
authors.lastname: Gregory
authors.affiliation: Presscott Associates, a division of ParenteBeard, New York, New York; Fairleigh Dickinson University, Teaneck, New Jersey.
authors.forename: Dennis
authors.initials: D
authors.lastname: Scotti
authors.affiliation: Mercy Heart & Vascular Institute, Sacramento, California.
authors.forename: Sean
authors.initials: S
authors.lastname: Bailey
authors.affiliation: Mercy Heart & Vascular Institute, Sacramento, California.
authors.forename: Scott
authors.initials: S
authors.lastname: Brunton
authors.affiliation: Regional Cardiology Associates, Sacramento, California; Mercy Heart & Vascular Institute, Sacramento, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Chang
authors.affiliation: Helmsley Cardiac Arrhythmia Service, Mount Sinai School of Medicine, New York, New York.
authors.forename: André
authors.initials: A
authors.lastname: d'Avila
mesh_terms: D000368:Aged; D018780:Body Surface Potential Mapping / Q000379:methods; D017115:Catheter Ablation / Q000379:methods*; D002921:Cicatrix; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006353:Heart-Assist Devices; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000601:surgery*; D016896:Treatment Outcome
keywords: Catheter ablation; Hospital length of stay; Ischemic cardiomyopathy; Non–ischemic cardiomyopathy; Percutaneous left ventricular assist device; Ventricular tachycardia