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

Nilesh Mathuria, Geru Wu, Francia Rojas-Delgado, Mossaab Shuraih, Mehdi Razavi, Andrew Civitello, Leo Simpson, Guilherme Silva, Suwei Wang, MacArthur A. Elayda, Bharat Kantharia, Steve Singh, O. H. Frazier, Jie Cheng

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Purpose: 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.

Original languageEnglish (US)
Pages (from-to)27-34
Number of pages8
JournalJournal of Interventional Cardiac Electrophysiology
Volume48
Issue number1
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

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Heart-Assist Devices
Catheter Ablation
Ventricular Tachycardia
Heart Diseases
Mortality
Hemodynamics
Cardiomyopathies
Patient Selection

Keywords

  • Ablation
  • Cardiomyopathy
  • Percutaneous left ventricular assist device
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

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. / Mathuria, Nilesh; Wu, Geru; Rojas-Delgado, Francia; Shuraih, Mossaab; Razavi, Mehdi; Civitello, Andrew; Simpson, Leo; Silva, Guilherme; Wang, Suwei; Elayda, MacArthur A.; Kantharia, Bharat; Singh, Steve; Frazier, O. H.; Cheng, Jie.

In: Journal of Interventional Cardiac Electrophysiology, Vol. 48, No. 1, 01.01.2017, p. 27-34.

Research output: Contribution to journalArticle

Mathuria, N, Wu, G, Rojas-Delgado, F, Shuraih, M, Razavi, M, Civitello, A, Simpson, L, Silva, G, Wang, S, Elayda, MA, Kantharia, B, Singh, S, Frazier, OH & Cheng, J 2017, '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', Journal of Interventional Cardiac Electrophysiology, vol. 48, no. 1, pp. 27-34. https://doi.org/10.1007/s10840-016-0168-8
Mathuria, Nilesh ; Wu, Geru ; Rojas-Delgado, Francia ; Shuraih, Mossaab ; Razavi, Mehdi ; Civitello, Andrew ; Simpson, Leo ; Silva, Guilherme ; Wang, Suwei ; Elayda, MacArthur A. ; Kantharia, Bharat ; Singh, Steve ; Frazier, O. H. ; Cheng, Jie. / 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. In: Journal of Interventional Cardiac Electrophysiology. 2017 ; Vol. 48, No. 1. pp. 27-34.
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abstract = "Purpose: 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.",
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AU - Mathuria, Nilesh

AU - Wu, Geru

AU - Rojas-Delgado, Francia

AU - Shuraih, Mossaab

AU - Razavi, Mehdi

AU - Civitello, Andrew

AU - Simpson, Leo

AU - Silva, Guilherme

AU - Wang, Suwei

AU - Elayda, MacArthur A.

AU - Kantharia, Bharat

AU - Singh, Steve

AU - Frazier, O. H.

AU - Cheng, Jie

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N2 - Purpose: 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.

AB - Purpose: 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.

KW - Ablation

KW - Cardiomyopathy

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