Delayed removal of a percutaneous left ventricular assist device for patients undergoing catheter ablation of ventricula
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Delayed removal of a percutaneous left ventricular assist device for patients undergoing catheter ablation of ventricular tachycardia is associated with increased 90-day mortality Qi Chen 1 & Mark Pollet 2 & Adwait Mehta 1 & Shuyu Wang 3 & Juliette Dean 1 & Jennifer Parenti 1 & Francia Rojas-Delgado 1 & Leo Simpson 2 & Jie Cheng 1 & Nilesh Mathuria 1 Received: 24 May 2020 / Accepted: 10 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Assess if timing of removal of a percutaneous left ventricular assist device (pLVAD) after ventricular tachycardia (VT) ablation alters patient outcomes. Methods Sixty-nine patients underwent pLVAD support. Patients were divided into early (< 24 h, n = 43) and delayed (≥ 24 h, n = 26) removal groups after ablation. Factors for delayed pLVAD removal and predictors of 90-day mortality were analyzed. Results The delayed removal group had lower LVEF (27.1 ± 9.3% vs. 20.6 ± 5.4%, p = 0.002), greater percentage LVEF < 25% (58.1% vs. 84.6%, p = 0.02), and more VT storm (41.9% vs. 96.2%, p < 0.001). Ventricular fibrillation (VF) was induced in 9/69 (13%), with incidence higher in delayed removal group (27% vs. 5%, p = 0.002). VT storm (OR = 34.72, 95% CI, 4.30–280.33; p = 0.001), LVEF < 25% (OR = 3.95, 95% CI, 1.16–13.48; p = 0.03), and VF induced during ablation (OR = 9.25, 95% CI, 1.71– 50.0; p = 0.01) were associated with delayed pLVAD removal in univariate analysis. Delayed pLVAD removal had a significantly higher 90-day mortality rate (2.3% vs 30.2%; p < 0.001). Univariate Cox proportional hazard regression analysis revealed delayed pLVAD removal was a significant predictor of 90-day mortality. Conclusions Prolonged pLVAD insertion (≥ 24 h) after VT ablation was associated with VT storm, LVEF < 25%, and VF induced during ablation. Delayed pLVAD removal was a significant predictor of 90-day mortality in patients undergoing VT ablation. Keywords Ventricular tachycardia . Ablation . Percutaneous left ventricular assist device . Mortality . Impella . TandemHeart . Catheter . Ventricular fibrillation . Hemodynamic support
Abbreviations ACEI/ARB Angiotensin-converting enzyme inhibitor/ angiotensin receptor blocker ECMO Extracorporeal mechanical oxygenation pLVAD Percutaneous left ventricular assist device IABP Intra-aortic balloon pump
Qi Chen and Mark Pollet contributed equally to this work. * Nilesh Mathuria [email protected] 1
Division of Cardiac Electrophysiology, Texas Heart Institute, MC 2-225, PO BOX 20345, Houston, TX 77225-0345, USA
2
Division of Cardiology, Baylor College of Medicine, Houston, TX, USA
3
Texas A&M University, College Station, TX, USA
LAVA LVEF NYHA VT VF
Local abnormal ventricular activity Left ventricular ejection fraction New York Heart Association Ventricular tachycardia Ventricular fibrillation
1 Introduction Catheter ablation is an established therapy in the management of ventricular tachycardia (VT) in patients with structural heart disease [1, 2]. In selected high-risk patients, a percutaneo
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