Author + information
- Received March 2, 2017
- Revision received June 23, 2017
- Accepted July 6, 2017
- Published online December 18, 2017.
- Mohit K. Turagam, MDa,
- Venkat Vuddanda, MDb,
- Donita Atkins, RN, BSNb,
- Pasquale Santangeli, MD, PhDc,
- David S. Frankel, MDc,
- Roderick Tung, MDd,
- Marmar Vaseghi, MDe,
- William H. Sauer, MDf,
- Wendy Tzou, MDf,
- Nilesh Mathuria, MDg,
- Shiro Nakahara, MDh,
- Timm M. Dickfeld, MDi,
- T. Jared Bunch, MDj,
- Peter Weiss, MDj,
- Luigi Di Biase, MD, PhDk,l,
- Venkat Tholakanahalli, MDm,
- Kairav Vakil, MDm,
- Usha B. Tedrow, MDn,
- William G. Stevenson, MDn,
- Paolo Della Bella, MDo,
- Kalyanam Shivkumar, MD, PhDe,
- Francis E. Marchlinski, MDc,
- David J. Callans, MDc,
- Andrea Natale, MDk,
- Madhu Reddy, MDb and
- Dhanunjaya Lakkireddy, MDb,∗ ()
- aDivision of Cardiovascular Medicine, University of Missouri Hospital and Clinics, Columbia, Missouri
- bDivision of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
- cCardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- dPritzker School of Medicine, University of Chicago Medicine, Chicago, Illinois
- eUCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
- fUniversity of Colorado, Aurora, Colorado
- gSt. Luke’s Health System/Texas Heart Institute and University of Texas Health Science Center, Houston, Texas
- hDokkyo Medical University Koshigaya Hospital, Saitama, Japan
- iUniversity of Maryland Medical Center, Baltimore, Maryland
- jIntermountain Heart Institute, Intermountain Medical Center, Murray, Utah
- kTexas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, Texas
- lAlbert Einstein College of Medicine at Montefiore Hospital, New York, New York
- mUniversity of Minnesota Medical Center, Minneapolis VA Medical Center, Minneapolis, Minnesota
- nBrigham and Women’s Hospital, Boston, Massachusetts
- oHospital San Raffaele, Milan, Italy
- ↵∗Address for correspondence:
Dr. Dhanunjaya Lakkireddy, Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, 3901 Rainbow Boulevard, MS3006, Kansas City, Kansas 66160.
Objectives This study sought to evaluate the clinical outcomes of patients receiving hemodynamic support (HS) during ventricular tacchycardia (VT) ablation.
Background There are limited real-world data evaluating its effect of HS in ablation outcomes.
Methods 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.
Results 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.
Conclusions 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.
All the authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors' institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received March 2, 2017.
- Revision received June 23, 2017.
- Accepted July 6, 2017.
- 2017 American College of Cardiology Foundation
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