title: Outcomes of pre-emptive and rescue use of percutaneous left ventricular assist device in patients with structural heart disease undergoing catheter ablation of ventricular tachycardia.
abstract: OBJECTIVE
  Patient selection and timing of percutaneous left ventricular assist device (pLVAD) insertion for maximal benefit during ventricular tachycardia (VT) ablation is not well defined. We aimed to assess the outcomes of pre-emptive and rescue use of pLVAD during VT ablation in patients with ischemic and non-ischemic cardiomyopathy.
  
  
  METHODS
  Between January 2009 and October 2011, 93 patients underwent VT ablation. Three groups were compared: (1) Rescue group (n = 12)-patients who required emergent pLVAD insertion due to hemodynamic collapse during VT ablation, (2) Pre-emptive group (n = 24)-patients who had pre-ablation pLVAD insertion, and (3) Non-pLVAD group (n = 57)-patients who did not undergo pLVAD insertion. Procedural outcomes including 30-day mortality were compared.
  
  
  RESULTS
  Thirty-day mortality was higher in the Rescue group compared to the Pre-emptive group (58 vs. 4 %, p = 0.003) and non-pLVAD (58 vs. 3 %, p = 0.001) group. There was no significant difference in 30-day mortality or long-term freedom of VT between the pre-emptive and non-pLVAD groups.
  
  
  CONCLUSIONS
  Despite rescue pLVAD insertion, hemodynamic collapse during VT ablation is associated with a persistently high 30-day mortality. Further studies are warranted to predict hemodynamic collapse and to refine the role of pLVAD in this setting.
authors: Division of Cardiology, Baylor St. Luke's Medical Center/Texas Heart Institute, PO Box 20345, Houston, TX, 77225-0345, USA. nimathuria@texasheart.org.
authors: Nilesh
authors: http://orcid.org/0000-0003-0721-6827
authors: N
authors: Mathuria
authors: Division of Cardiology, Baylor St. Luke's Medical Center/Texas Heart Institute, PO Box 20345, Houston, TX, 77225-0345, USA.
authors: Geru
authors: G
authors: Wu
authors: Division of Cardiology, Baylor St. Luke's Medical Center/Texas Heart Institute, PO Box 20345, Houston, TX, 77225-0345, USA.
authors: Francia
authors: F
authors: Rojas-Delgado
authors: Division of Cardiology, Baylor St. Luke's Medical Center/Texas Heart Institute, PO Box 20345, Houston, TX, 77225-0345, USA.
authors: Mossaab
authors: M
authors: Shuraih
authors: Division of Cardiology, Baylor St. Luke's Medical Center/Texas Heart Institute, PO Box 20345, Houston, TX, 77225-0345, USA.
authors: Mehdi
authors: M
authors: Razavi
authors: Division of Cardiology, Baylor St. Luke's Medical Center/Texas Heart Institute, PO Box 20345, Houston, TX, 77225-0345, USA.
authors: Andrew
authors: A
authors: Civitello
authors: Division of Cardiology, Baylor St. Luke's Medical Center/Texas Heart Institute, PO Box 20345, Houston, TX, 77225-0345, USA.
authors: Leo
authors: L
authors: Simpson
authors: Division of Cardiology, Baylor St. Luke's Medical Center/Texas Heart Institute, PO Box 20345, Houston, TX, 77225-0345, USA.
authors: Guilherme
authors: G
authors: Silva
authors: Division of Biostatistics, Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, TX, USA.
authors: Suwei
authors: S
authors: Wang
authors: Division of Biostatistics, Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, TX, USA.
authors: MacArthur
authors: M
authors: Elayda
authors: University of Texas Health Science Center at Houston, Houston, TX, USA.
authors: Bharat
authors: B
authors: Kantharia
authors: Division of Cardiovascular Surgery, Baylor College of Medicine/Texas Heart Institute, Houston, TX, USA.
authors: Steve
authors: S
authors: Singh
authors: Division of Cardiovascular Surgery, Baylor College of Medicine/Texas Heart Institute, Houston, TX, USA.
authors: O H
authors: OH
authors: Frazier
authors: Division of Cardiology, Baylor St. Luke's Medical Center/Texas Heart Institute, PO Box 20345, Houston, TX, 77225-0345, USA.
authors: Jie
authors: J
authors: Cheng
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000401:mortality* / Q000517:prevention & control; D017115:Catheter Ablation / Q000379:methods / Q000401:mortality*; D003131:Combined Modality Therapy / Q000401:mortality / Q000706:statistics & numerical data; D015897:Comorbidity; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012307:Risk Factors; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000401:mortality* / Q000628:therapy*; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Ablation; Cardiomyopathy; Percutaneous left ventricular assist device; Ventricular tachycardia