Effects of hemodynamic support on arrhythmia-free survival following catheter ablation of ventricular arrhythmias

Abstract

Abstract Background Radiofrequency-guided catheter ablation is an established therapy for ventricular tachycardia (VA). Hemodynamic support (HS) is often required for patients suffering from incessant VA to guide ablation. Data on the outcome of patients receiving HS during VA ablation procedures are lacking. Purpose The aim of this observational study was to analyze the acute procedural success as well as long-term 36-month-VA-recurrence rates and mortality in patients requiring HS during VA ablation procedures. Methods Data from consecutive patients receiving HS during VA ablation procedures between 2015-2023 were analyzed. HS was defined as the use of an Impella, an extracorporeal membrane oxygenation (ECMO) or a left ventricular assist device (LVAD). HS-group patients were compared to patients that underwent VA ablation procedures without HS. All patients were continuously followed up in our outpatient clinic. Data on procedural parameters, acute success and complications as well as long-term VA-free survival and mortality were analyzed. Results A total of 95 consecutive patients (mean age 60.9 ± 11.0 years, 15% female) were included. 62 patients (65%, mean age 60.4±9.4 years, 16% female) receiving HS (ECMO or Impella: n=26, 42%; ECMO+Impella: n=7, 11%; LVAD: n=29, 47%) were compared to those without (mean age 61.7±13.5 years, 12 % female). In the HS-cohort a significantly lower left ventricular ejection fraction (LVEF) (p<0.001), a higher New York Heart Association (NYHA) functional class (p=0.013) and a more frequent antiarrhythmic drug use (p=0.045) was documented. Fluoroscopy times were significantly longer in the HS-group (HS: 10:22 ± 07:04 vs. no HS: 05:52 ± 02:50 minutes, p<0.001). Acute procedural success (HS: n=59, 95% vs. no HS: n=33, 100%, p=0.549) and major procedure complications (HS: n=4. 6% vs. no HS: n=4. 6%, p=1.000) were comparable between the two groups. Nevertheless, patients receiving HS had a significantly higher in-hospital mortality (HS: n=20, 32 % vs. no HS: n=2, 6%, p=0.004). The estimated 36-month-VA-free survival was comparable between the groups (Log-rank p=0.114). But Kaplan-Meier-plot analyses revealed a significantly higher estimated mortality in patients receiving HS (Log-rank p=0.002) (Figure 1). Between the subgroups (ECMO or Impella vs. LVAD) no statistically relevant differences were observed (Log-rank p=0.466). Multivariate analyses revealed HS as an independent predictor for mortality (Hazard ratio (HR) 3.259, Confidence Interval (CI) 1.060-10.015, p=0.039), but not for VA-recurrence. Conclusion In the specific cohort of patients receiving HS, VA ablation procedures seem to be safe and effective with comparable acute and long-term success- and complication-rates. The need for HS seems to be associated with an increased risk for mortality. Further studies are required to validate our initial observations.Kaplan-Meier-plot on 36-month survival