Temporary Percutaneous Left Ventricular Support for Ablation of Untolerated Ventricular Tachycardias

Abstract

Catheter ablation is increasingly recognized as an important option for the treatment of ventricular tachycardia (VT) in the serious clinical settings of frequent implantable cardioverter defibrillator shocks, and arrhythmia storms, in a variety of structural heart diseases.1 The high incidence of VTs that are not hemodynamically tolerated forces challenges to the traditional approaches of using activation and entrainment mapping to localize the ablation target area, in favor of a strategy of substrate modification that can be performed during sinus rhythm. In some patients, however, a clear target cannot be detected during sinus rhythm; this frequently occurs in some forms of nonischemic cardiomyopathies. More recently, interest is growing in the possibility of making VT tolerable through cardiopulmonary support. Article see p 1202 In this issue of Circulation: Arrythmia and Electrophysiology , Ostadal et al2 provide experimental data on the different capabilities offered by 3 commercially available support systems. It should be kept in mind, however, that these systems are Food and Drug Administration–approved only to support temporary high-risk situations. The data offered in this study are limited in that they provide only information related to systemic arterial pressure in healthy animals and do not allow any evaluation of the different levels of perfusion attained at individual critical organs, ie, brain or kidney. The study does, however, offer a comparative evaluation of the performances of these different systems and offers the opportunity to discuss advantages and limitation of their use. Percutaneous left ventricular assist devices (pLVAD) are increasingly used in few high-volume and skilled centers around the world in an attempt to achieve hemodynamic support during previously nontolerated ventricular arrhythmias to allow use of electrophysiological maneuvers to identify the critical isthmus of the circuit where an effective ablation will produce a permanent interruption of the VT. It is hoped that …