Abstract 17073: Intraprocedural Use of Dopamine During Ventricular Tachycardia (VT) Ablation is Associated With Greater Number of VTs Induced and Increased Need for Cardioversions

Abstract

Introduction: Hemodynamic drugs are frequently used in patients with heart failure, despite arrhythmogenic effects. In certain situations, dopamine has been associated with increased arrhythmias and mortality. There are no known studies reviewing the impact of hemodynamic drugs used during VT ablations on procedural outcomes. Hypothesis: We sought to determine whether intra-procedural use of dopamine, dobutamine, or phenylephrine affected the number of induced VTs, required cardioversions, or the acute success of VT ablations. Methods: We conducted a retrospective review for all VT ablations from 2013-17 at our institution. Patient and procedural details were collected for 149 VT ablations. Results: The cohort was 81% male, and 67% had cardiomyopathy of which 53% were ischemic with a mean EF of 29.1% (CI 26.7- 31.4). Vasoactive drugs were used in 87% of patients undergoing VT ablation: phenylephrine (67%), dopamine (40%), dobutamine (37%). After adjusting for heart failure and procedural time, use of dopamine, but not phenylephrine or dobutamine, was associated with a greater number of induced VTs (p =0.02, Fig. 1a). Adjusting for the same factors, dopamine and dobutamine were significantly associated with increased need for cardioversions (p < 0.01). Dobutamine, but not dopamine or phenylephrine, was associated with lower acute procedural success (OR 0.25, CI 0.08-0.77, P = 0.01). Conclusions: Different vasoactive drugs may have differential effects on VT ablation outcomes. The focus of VT ablation is usually on VT mechanism and substrate, but attention to other factors, such as vasoactive drugs, may be warranted to determine their effect on procedural outcomes.