Hemodynamic Support in Ventricular Tachycardia Ablation An International VT Ablation Center Collaborative Group Study

Mohit K. Turagam, Venkat Vuddanda, Donita Atkins, Pasquale Santangeli, David S. Frankel, Roderick Tung, Marmar Vaseghi, William H. Sauer, Wendy Tzou, Nilesh Mathuria, Shiro Nakahara, Timm M. Dickfeld, T. Jared Bunch, Peter Weiss, Luigi Di Biase, Venkat Tholakanahalli, Kairav Vakil, Usha B. Tedrow, William G. Stevenson, Paolo Della Bella, Kalyanam Shivkumar, Francis E. Marchlinski, David J. Callans, Andrea Natale, Madhu Reddy, Dhanunjaya Lakkireddy

This study sought to evaluate the clinical outcomes of patients receiving hemodynamic support (HS) during ventricular tacchycardia (VT) ablation. There are limited real-world data evaluating its effect of HS in ablation outcomes. An analysis of 1,655 patients from the International VT Ablation Center Collaborative group was performed. A total of 105 patients received HS with percutaneous ventricular assist device. Patients in the HS group had lower left ventricular ejection fraction (LVEF), higher New York Heart Association (NYHA) functional class, and more implantable cardioverter-defibrillator (ICD) shocks, VT storm, and antiarrhythmic drug use (all p < 0.05). The HS group also required significantly longer fluoroscopy, procedure, and total lesion time. Acute procedural success (71.8% vs. 73.7%; p = 0.04) was significantly lower and complications (12.5% vs. 6.5%; p = 0.03) and 1-year mortality (34.7% vs. 9.3%; p < 0.001) were significantly higher in the HS group. Multivariate Cox regression analysis demonstrated HS as an independent predictor of mortality (hazard ratio: 5.01; 95% confidence interval: 3.44 to 7.20; p < 0.001). There was no significant difference in VT recurrence between groups. In a subgroup analysis including LVEF ≤20% and NYHA functional class III to IV patients, acute procedural success (74.0% vs. 70.5%; p = 0.8), complications (15.6% vs. 7.8%; p = 0.2), VT recurrence (30.2% vs. 38.1%; p = 0.44), and 1-year mortality (40.0% vs. 28.8%; p = 0.2) were no different between the HS and no-HS groups. Patients requiring HS were sicker with multiple comorbidities and, as expected, had a significantly higher 1-year mortality than did those patients in the no-HS group. In patients with LVEF ≤20% and NYHA functional class III to IV, there was also no significant difference in clinical outcomes when compared with no HS. Further studies are needed to systematically evaluate patients undergoing VT ablation receiving HS.