Cardiopulmonary Support During Catheter Ablation of Ventricular Arrhythmias With Hemodynamic Instability: The Role of Inducibility

Grimaldi, Massimo; Marino, Maria M; Vitulano, Nicola; Quadrini, Federico; Troisi, F; Caporusso, Nicola; Perniciaro, Vera; Caruso, Rosa; Duni, Nicola; Cecere, Giacomo; Martinelli, A.; Guida, Pietro; Monte, Vito Del; Langialonga, Tommaso; Biase, Luigi Di; Monaco, Antonio Di

doi:10.3389/fcvm.2021.747858

Cited by 6 publications

(1 citation statement)

References 27 publications

(23 reference statements)

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“…57 Recently, Grimaldi et al showed that VA-ECMOfacilitated VT ablation is effective in preventing acute procedural heart failure and reducing the arrhythmic burden at long-term follow-up. 95 Unfortunately, there is no study powered for direct comparison of Impella-versus VA-EMCO-facilitated VT ablation to date. Overall, Impella-facilitated VT ablation can provide hemodynamic support during prolonged VT episodes.…”

Section: Impella-facilitated Ablation Of Vtmentioning

confidence: 99%

Percutaneous Transvalvular Microaxial Flow Pump Support in Cardiology

Lüsebrink¹,

Kellnar²,

Krieg³

et al. 2022

Circulation

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The Impella device (Impella, Abiomed, Danvers, MA) is a percutaneous transvalvular microaxial flow pump that is currently used for (1) cardiogenic shock, (2) left ventricular unloading (combination of venoarterial extracorporeal membrane oxygenation and Impella concept), (3) high-risk percutaneous coronary interventions, (4) ablation of ventricular tachycardia, and (5) treatment of right ventricular failure. Impella-assisted forward blood flow increased mean arterial pressure and cardiac output, peripheral tissue perfusion, and coronary blood flow in observational studies and some randomized trials. However, because of the need for large-bore femoral access (14 F for the commonly used Impella CP device) and anticoagulation, the incidences of bleeding and ischemic complications are as much as 44% and 18%, respectively. Hemolysis is reported in as many as 32% of patients and stroke in as many as 13%. Despite the rapidly growing use of the Impella device, there are still insufficient data on its effect on outcome and complications on the basis of large, adequately powered randomized controlled trials. The only 2 small and also underpowered randomized controlled trials in cardiogenic shock comparing Impella versus intra-aortic balloon pump did not show improved mortality. Several larger randomized controlled trials are currently recruiting patients or are in preparation in cardiogenic shock (DanGer Shock [Danish-German Cardiogenic Shock Trial; NCT01633502]), left ventricular unloading (DTU-STEMI [Door-To-Unload in ST-Segment–Elevation Myocardial Infarction; NCT03947619], UNLOAD ECMO [Left Ventricular Unloading to Improve Outcome in Cardiogenic Shock Patients on VA-ECMO], and REVERSE [A Prospective Randomised Trial of Early LV Venting Using Impella CP for Recovery in Patients With Cardiogenic Shock Managed With VA ECMO; NCT03431467]) and high-risk percutaneous coronary intervention (PROTECT IV [Impella-Supported PCI in High-Risk Patients With Complex Coronary Artery Disease and Reduced Left Ventricular Function; NCT04763200]).

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Section: Impella-facilitated Ablation Of Vtmentioning

confidence: 99%

Percutaneous Transvalvular Microaxial Flow Pump Support in Cardiology

Lüsebrink¹,

Kellnar²,

Krieg³

et al. 2022

Circulation

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ECMO for drug‐refractory electrical storm without a reversible trigger: a retrospective multicentric observational study

Durães‐Campos,

Costa,

Ferreira

et al. 2024

ESC Heart Failure

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AimsDrug‐refractory electrical storm (ES) is a life‐threatening medical emergency. We describe the use of venoarterial extracorporeal membrane oxygenation (VA‐ECMO) in drug‐refractory ES without a reversible trigger, for which specific guideline recommendations are still lacking.Methods and resultsRetrospective observational study in four Iberian centres on the indications, treatment, complications, and outcome of drug‐refractory ES not associated with acute coronary syndromes, decompensated heart failure, drug toxicity, electrolyte disturbances, endocrine emergencies, concomitant acute illness with fever, or poor compliance with anti‐arrhythmic drugs, requiring VA‐ECMO for circulatory support. Thirty‐four (6%) out of 552 patients with VA‐ECMO for cardiogenic shock were included [71% men; 57 (44–62) years], 65% underwent cardiopulmonary resuscitation before VA‐ECMO implantation, and 26% during cannulation. Left ventricular unloading during VA‐ECMO was used in 8 (24%) patients: 3 (9%) with intraaortic balloon pump, 3 (9%) with LV vent, and 2 (6%) with Impella. Thirty (88%) had structural heart disease and 8 (24%) had an implantable cardioverter‐defibrillator. The drug‐refractory ES was mostly due to monomorphic ventricular tachycardia (VT) and ventricular fibrillation (VF) (59%), isolated monomorphic VT (26%), polymorphic VT (9%), or VF (6%). Thirty‐one (91%) required deep sedation, 44% overdrive pacing, 36% catheter ablation, and 26% acute autonomic modulation. The main complications were nosocomial infection (47%), bleeding (24%), and limb ischaemia (21%). Eighteen (53%) were weaned from VA‐ECMO, and 29% had heart transplantation. Twenty‐seven (79%) survived to hospital discharge (48 (33–82) days). Non‐survivors were older [62 (58–67) vs. 54 (43–58); P < 0.01] and had a higher first rhythm disorder‐to‐ECMO interval [0 (0–2) vs. 2 (1‐11) days; P = 0.02]. Seven (20%) had rehospitalization during follow‐up [29 (12–48) months], with ES recurrence in 6%.ConclusionsVA‐ECMO bridged drug‐refractory ES without a reversible trigger with a high success rate. This required prolonged hospital stays and coordination between the ECMO centre, the electrophysiology laboratory, and the heart transplant programme.

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