Abstract 18282: Use of Percutaneous External Circulatory Support in Patients Undergoing Ventricular Tachycardia Ablation - a Multicenter Experience

Introduction: Recurrent ventricular tachycardia (VT) in patients with cardiomyopathy and advanced heart failure contributes significant morbidity and mortality. Defibrillator shocks and hemodynamic compromise present a greater therapeutic challenge. VT ablation is challenging in these pts and outcomes using hemodynamic support systems is lacking. Methods: From a multicenter prospective database, all patients who underwent radiofrequency (RF) ablation for VT between 2006 and 2010 were studied. Pts requiring hemodynamic support during ablation were identified. Inclusion criteria were - clinical hemodynamic instability, unstable VTs and/or poor LVEF(<20%). Patients were grouped into 3 groups based on the type of hemodynamic support (operator choice), group 1 (Impella), group 2 (balloon pump) and group 3 (TandemHeart). Results: A total of 31 patients (65 ± 11yrs, 29 (94%) Caucasians, 29(94%) male) were studied. Group1 had 3, group 2 had 9 and group 3 had 19 patients. The baseline, past medical and medication histories including antiarrhythmic drugs were similar. Overall, the mean LVEF was 25±13 and 23 (74%) had non-ischemic cardiomyopathy. On average, 3.87 ± 1.82VTs were induced during ablation and in 26 (84%), clinical VT was induced. Overall acute success rate was 26 (84%), short-term mortality was 5 (16%) and mortality at 12 month follow-up was 6 (19%). Major complications noted in 10 (32%). Significant acute success rate (100%) was noted in group 2 (Balloon pump) while mortality is lower in group 1 (Impella). (Figure1). Conclusion: Our study showed significant mortality benefit when a hemodynamic support is used in patients with hemodynamically unstable VT when compared to historical outcomes. In subgroup analysis, Impella group showed improved mortality. However, no major derivations can be made about the superiority of one device over the other due to the relative smaller numbers.