5 years ago

Outcomes of Rescue Cardiopulmonary Support for Periprocedural Acute Hemodynamic Decompensation in Patients Undergoing Catheter Ablation of Electrical Storm

In patients with ventricular tachycardia/fibrillation (VT/VF) electrical storm (ES) undergoing catheter ablation (CA), hypotension due to refractory VT/VF, use of anesthesia and cardiac stunning due to repeated ICD shocks might precipitate acute hemodynamic decompensation (AHD). Objective We evaluated the outcomes of emergent cardiopulmonary support with extracorporeal membrane oxygenation (ECMO) to rescue AHD in patients undergoing CA of ES. Methods Between 2010 and 2016, 21 patients with ES (VT in 11 and PVC-triggered VF in 10) were referred for CA and had periprocedural AHD requiring emergent ECMO support. Results In 14 patients AHD occurred a mean of 1.5±1.7 days before the procedure. In the remaining 7 patients AHD occurred during or shortly after the procedure. ECMO was successfully started in all patients. Ablation was performed in 18 patients (9 with VF and 9 with VT). In patients with VF, PVC suppression was achieved in 8/9 (89%) cases. In those with VT, noninducibility was achieved in 7/9 (78%). After a median follow-up of 10 days, 16 patients died (13 during the index admission). Death was due to refractory VT/VF in 4 cases, heart failure in 11 and non-cardiac cause in 1 case. Seven patients survived beyond 6 months post-ablation; 5 remained free of VT/VF and 3 ultimately received a destination therapy (heart transplantation in 2 and LVAD in 1). Conclusion In patients with ES undergoing CA, the outcomes of ECMO support as rescue intervention for AHD are poor. The majority of these patients die at short-term from refractory heart failure. Strategies to prevent AHD including pre-emptive use of hemodynamic support may improve survival.

Publisher URL: www.sciencedirect.com/science

DOI: S1547527117310846

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