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Percutaneous left ventricular assist devices in ventricular tachycardia ablation multicenter experience

  • Author(s): Reddy, YM
  • Chinitz, L
  • Mansour, M
  • Bunch, TJ
  • Mahapatra, S
  • Swarup, V
  • Di Biase, L
  • Bommana, S
  • Atkins, D
  • Tung, R
  • Shivkumar, K
  • Burkhardt, JD
  • Ruskin, J
  • Natale, A
  • Lakkireddy, D
  • et al.
Abstract

Background-Data on relative safety, efficacy, and role of different percutaneous left ventricular assist devices for hemodynamic support during the ventricular tachycardia (VT) ablation procedure are limited. Methods and Results-We performed a multicenter, observational study from a prospective registry including all consecutive patients (N=66) undergoing VT ablation with a percutaneous left ventricular assist devices in 6 centers in the United States. Patients with intra-aortic balloon pump (IABP group; N=22) were compared with patients with either an Impella or a TandemHeart device (non-IABP group; N=44). There were no significant differences in the baseline characteristics between both the groups. In non-IABP group (1) more patients could undergo entrainment/activation mapping (82% versus 59%; P=0.046), (2) more number of unstable VTs could be mapped and ablated per patient (1.05±0.78 versus 0.32±0.48; P<0.001), (3) more number of VTs could be terminated by ablation (1.59±1.0 versus 0.91±0.81; P=0.007), and (4) fewer VTs were terminated with rescue shocks (1.9±2.2 versus 3.0±1.5; P=0.049) when compared with IABP group. Complications of the procedure trended to be more in the non-IABP group when compared with those in the IABP group (32% versus 14%; P=0.143). Intermediate term outcomes (mortality and VT recurrence) during 12±5-month follow-up were not different between both groups. Left ventricular ejection fraction =15% was a strong and independent predictor of in-hospital mortality (53% versus 4%; P<0.001). Conclusions-Impella and TandemHeart use in VT ablation facilitates extensive activation mapping of several unstable VTs and requires fewer rescue shocks during the procedure when compared with using IABP. © 2014 American Heart Association, Inc.

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