Extracorporeal Membrane Oxygenation for Hemodynamic Support of Ventricular Tachycardia Ablation

Francesca Baratto, Federico Pappalardo, Teresa Oloriz, Caterina Bisceglia, Pasquale Vergara, John Silberbauer, Nicolò Albanese, Manuela Cireddu, Giuseppe D'Angelo, Ambra Licia Di Prima, Fabrizio Monaco, Gabriele Paglino, Andrea Radinovic, Damiano Regazzoli, Simona Silvetti, Nicola Trevisi, Alberto Zangrillo, Paolo Della Bella

Research output: Contribution to journalArticle

Abstract

Background - We report the experience in a cohort of consecutive patients receiving extracorporeal membrane oxygenation during catheter ablation of unstable ventricular tachycardia (VT) at our center. Methods and Results - From 2010 to 2015, extracorporeal membrane oxygenation was initiated in 64 patients (average age: 63±15 years; left ventricular ejection fraction in 27±9%; cardiogenic shock in 23%, and electrical storm in 62% of patients) undergoing 74 unstable VT catheter ablation procedures. At least one VT was terminated in 81% of procedures with baseline inducible VT, and VT noninducibility was achieved in 69%. Acute heart failure occurred in 5 patients: 3 underwent emergency heart transplantation, 1 had left ventricular assist device (LVAD) implantation, and 1 patient eventually died because of subsequent mesenteric ischemia. All other patients were discharged alive. After a median follow-up of 21 months (13-28 months), VT recurrence was 33%; overall survival was 56 out of 64 patients (88%). Extracorporeal membrane oxygenation-supported ablation was the bridge to LVAD in 6.9% and to heart transplantation in 3.5% of patients. VT recurrence was related to ablation success (after 180 days of follow up: 19% when VT was noninducible, 42% if nonclinical VT was inducible, 75% when clinical VT was inducible, and 75% in untested patients, P<0.001). Incidence of all-cause death, heart transplantation, and LVAD was independently related to ablation outcome (at 180 days of follow-up: 9% when noninducibility was achieved, 50% in case of inducible VT, and 75% in untested patients, P<0.001). At multivariable analyses, noninducibility (hazard ratio 0.198; P=0.001) and left ventricular ejection fraction (hazard ratio 0.916; P=0.008) correlated with all-cause death, LVAD, and heart transplantation. Conclusions - Ablation of unstable VTs can be safely supported by extracorporeal membrane oxygenation, which allows rhythm stabilization with low procedure mortality, bridging decompensated patients to permanent LVAD or heart transplantation. Successful ablation is associated with better outcomes than unsuccessful ablation.

Original languageEnglish
Article numbere004492
JournalCirculation: Arrhythmia and Electrophysiology
Volume9
Issue number12
DOIs
Publication statusPublished - Dec 1 2016

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Extracorporeal Membrane Oxygenation
Ventricular Tachycardia
Hemodynamics
Heart-Assist Devices
Heart Transplantation
Catheter Ablation
Stroke Volume
Cause of Death
Recurrence
Cardiogenic Shock
Emergencies
Heart Failure

Keywords

  • cardiac arrhythmias
  • catheter ablation
  • heart failure
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Extracorporeal Membrane Oxygenation for Hemodynamic Support of Ventricular Tachycardia Ablation. / Baratto, Francesca; Pappalardo, Federico; Oloriz, Teresa; Bisceglia, Caterina; Vergara, Pasquale; Silberbauer, John; Albanese, Nicolò; Cireddu, Manuela; D'Angelo, Giuseppe; Di Prima, Ambra Licia; Monaco, Fabrizio; Paglino, Gabriele; Radinovic, Andrea; Regazzoli, Damiano; Silvetti, Simona; Trevisi, Nicola; Zangrillo, Alberto; Della Bella, Paolo.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 9, No. 12, e004492, 01.12.2016.

Research output: Contribution to journalArticle

Baratto, F, Pappalardo, F, Oloriz, T, Bisceglia, C, Vergara, P, Silberbauer, J, Albanese, N, Cireddu, M, D'Angelo, G, Di Prima, AL, Monaco, F, Paglino, G, Radinovic, A, Regazzoli, D, Silvetti, S, Trevisi, N, Zangrillo, A & Della Bella, P 2016, 'Extracorporeal Membrane Oxygenation for Hemodynamic Support of Ventricular Tachycardia Ablation', Circulation: Arrhythmia and Electrophysiology, vol. 9, no. 12, e004492. https://doi.org/10.1161/CIRCEP.116.004492
Baratto, Francesca ; Pappalardo, Federico ; Oloriz, Teresa ; Bisceglia, Caterina ; Vergara, Pasquale ; Silberbauer, John ; Albanese, Nicolò ; Cireddu, Manuela ; D'Angelo, Giuseppe ; Di Prima, Ambra Licia ; Monaco, Fabrizio ; Paglino, Gabriele ; Radinovic, Andrea ; Regazzoli, Damiano ; Silvetti, Simona ; Trevisi, Nicola ; Zangrillo, Alberto ; Della Bella, Paolo. / Extracorporeal Membrane Oxygenation for Hemodynamic Support of Ventricular Tachycardia Ablation. In: Circulation: Arrhythmia and Electrophysiology. 2016 ; Vol. 9, No. 12.
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abstract = "Background - We report the experience in a cohort of consecutive patients receiving extracorporeal membrane oxygenation during catheter ablation of unstable ventricular tachycardia (VT) at our center. Methods and Results - From 2010 to 2015, extracorporeal membrane oxygenation was initiated in 64 patients (average age: 63±15 years; left ventricular ejection fraction in 27±9{\%}; cardiogenic shock in 23{\%}, and electrical storm in 62{\%} of patients) undergoing 74 unstable VT catheter ablation procedures. At least one VT was terminated in 81{\%} of procedures with baseline inducible VT, and VT noninducibility was achieved in 69{\%}. Acute heart failure occurred in 5 patients: 3 underwent emergency heart transplantation, 1 had left ventricular assist device (LVAD) implantation, and 1 patient eventually died because of subsequent mesenteric ischemia. All other patients were discharged alive. After a median follow-up of 21 months (13-28 months), VT recurrence was 33{\%}; overall survival was 56 out of 64 patients (88{\%}). Extracorporeal membrane oxygenation-supported ablation was the bridge to LVAD in 6.9{\%} and to heart transplantation in 3.5{\%} of patients. VT recurrence was related to ablation success (after 180 days of follow up: 19{\%} when VT was noninducible, 42{\%} if nonclinical VT was inducible, 75{\%} when clinical VT was inducible, and 75{\%} in untested patients, P<0.001). Incidence of all-cause death, heart transplantation, and LVAD was independently related to ablation outcome (at 180 days of follow-up: 9{\%} when noninducibility was achieved, 50{\%} in case of inducible VT, and 75{\%} in untested patients, P<0.001). At multivariable analyses, noninducibility (hazard ratio 0.198; P=0.001) and left ventricular ejection fraction (hazard ratio 0.916; P=0.008) correlated with all-cause death, LVAD, and heart transplantation. Conclusions - Ablation of unstable VTs can be safely supported by extracorporeal membrane oxygenation, which allows rhythm stabilization with low procedure mortality, bridging decompensated patients to permanent LVAD or heart transplantation. Successful ablation is associated with better outcomes than unsuccessful ablation.",
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AU - Baratto, Francesca

AU - Pappalardo, Federico

AU - Oloriz, Teresa

AU - Bisceglia, Caterina

AU - Vergara, Pasquale

AU - Silberbauer, John

AU - Albanese, Nicolò

AU - Cireddu, Manuela

AU - D'Angelo, Giuseppe

AU - Di Prima, Ambra Licia

AU - Monaco, Fabrizio

AU - Paglino, Gabriele

AU - Radinovic, Andrea

AU - Regazzoli, Damiano

AU - Silvetti, Simona

AU - Trevisi, Nicola

AU - Zangrillo, Alberto

AU - Della Bella, Paolo

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Background - We report the experience in a cohort of consecutive patients receiving extracorporeal membrane oxygenation during catheter ablation of unstable ventricular tachycardia (VT) at our center. Methods and Results - From 2010 to 2015, extracorporeal membrane oxygenation was initiated in 64 patients (average age: 63±15 years; left ventricular ejection fraction in 27±9%; cardiogenic shock in 23%, and electrical storm in 62% of patients) undergoing 74 unstable VT catheter ablation procedures. At least one VT was terminated in 81% of procedures with baseline inducible VT, and VT noninducibility was achieved in 69%. Acute heart failure occurred in 5 patients: 3 underwent emergency heart transplantation, 1 had left ventricular assist device (LVAD) implantation, and 1 patient eventually died because of subsequent mesenteric ischemia. All other patients were discharged alive. After a median follow-up of 21 months (13-28 months), VT recurrence was 33%; overall survival was 56 out of 64 patients (88%). Extracorporeal membrane oxygenation-supported ablation was the bridge to LVAD in 6.9% and to heart transplantation in 3.5% of patients. VT recurrence was related to ablation success (after 180 days of follow up: 19% when VT was noninducible, 42% if nonclinical VT was inducible, 75% when clinical VT was inducible, and 75% in untested patients, P<0.001). Incidence of all-cause death, heart transplantation, and LVAD was independently related to ablation outcome (at 180 days of follow-up: 9% when noninducibility was achieved, 50% in case of inducible VT, and 75% in untested patients, P<0.001). At multivariable analyses, noninducibility (hazard ratio 0.198; P=0.001) and left ventricular ejection fraction (hazard ratio 0.916; P=0.008) correlated with all-cause death, LVAD, and heart transplantation. Conclusions - Ablation of unstable VTs can be safely supported by extracorporeal membrane oxygenation, which allows rhythm stabilization with low procedure mortality, bridging decompensated patients to permanent LVAD or heart transplantation. Successful ablation is associated with better outcomes than unsuccessful ablation.

AB - Background - We report the experience in a cohort of consecutive patients receiving extracorporeal membrane oxygenation during catheter ablation of unstable ventricular tachycardia (VT) at our center. Methods and Results - From 2010 to 2015, extracorporeal membrane oxygenation was initiated in 64 patients (average age: 63±15 years; left ventricular ejection fraction in 27±9%; cardiogenic shock in 23%, and electrical storm in 62% of patients) undergoing 74 unstable VT catheter ablation procedures. At least one VT was terminated in 81% of procedures with baseline inducible VT, and VT noninducibility was achieved in 69%. Acute heart failure occurred in 5 patients: 3 underwent emergency heart transplantation, 1 had left ventricular assist device (LVAD) implantation, and 1 patient eventually died because of subsequent mesenteric ischemia. All other patients were discharged alive. After a median follow-up of 21 months (13-28 months), VT recurrence was 33%; overall survival was 56 out of 64 patients (88%). Extracorporeal membrane oxygenation-supported ablation was the bridge to LVAD in 6.9% and to heart transplantation in 3.5% of patients. VT recurrence was related to ablation success (after 180 days of follow up: 19% when VT was noninducible, 42% if nonclinical VT was inducible, 75% when clinical VT was inducible, and 75% in untested patients, P<0.001). Incidence of all-cause death, heart transplantation, and LVAD was independently related to ablation outcome (at 180 days of follow-up: 9% when noninducibility was achieved, 50% in case of inducible VT, and 75% in untested patients, P<0.001). At multivariable analyses, noninducibility (hazard ratio 0.198; P=0.001) and left ventricular ejection fraction (hazard ratio 0.916; P=0.008) correlated with all-cause death, LVAD, and heart transplantation. Conclusions - Ablation of unstable VTs can be safely supported by extracorporeal membrane oxygenation, which allows rhythm stabilization with low procedure mortality, bridging decompensated patients to permanent LVAD or heart transplantation. Successful ablation is associated with better outcomes than unsuccessful ablation.

KW - cardiac arrhythmias

KW - catheter ablation

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