Author + information
- Fei Lu,
- Ioanna Apostolidou,
- Kenneth Liao,
- Ranjit John,
- Peter Eckman,
- Gladwin Das,
- David Benditt and
- Daniel Garry
Although hemodynamically unstable ventricular tachycardia (VT) may be ablated with the aid of mechanical hemodynamic support, little is known regarding the impact of possible hypo-perfusion of vital organs during such procedures.
This study investigated whether catheter ablation of unstable VT in the presence of mechanical hemodynamic support may cause acute renal injury.
Between April 22 2009 and September 14 2012, 15 consecutive patients (aged 63 ± 12 years with left ventricular ejection fraction of 19 ± 9%) who underwent ablation of hemodynamically unstable VT were included in this study. Hemodynamic support included percutaneous (Impella, n=5) and implantable (n=7) left ventricular assist device (LVAD) and percutaneous cardiopulmonary bypass (CPB, n=5).
Except for 2 case in which Impella® was used, hemodynamic support was considered adequate (with consistent mean blood pressure of >60 mmHg). VT was terminated at least once during ablation in all patients. Hemolysis was observed in 1 patient with Impella, and failure to insert Impella due to access problem was encountered in another. Surgical intervention was needed in 2 patients with Impella due to bleeding and entangled Preclose® device, respectively. The mean time under hemodynamic support was 243 ± 96 minutes, and time in VT was 98 ± 67 minutes. There was no significant change in creatinine, blood urea nitrogen, or glomerular filtration rate (GFR) at days 1 and 3 after the procedure compared to baseline values in all patients except one using Impella with bleeding and inadequate hemodynamic support.
Our data suggest that percutaneous CPB and implantable LVAD provide adequate hemodynamic support for ablation of unstable VT as evidenced by unchanged renal function after procedure. Impella, on the other hand, was associated with more complication risk, and may not provide sufficient hemodynamic support in unstable VT patients.
- 2013 American College of Cardiology Foundation