Outcomes of rescue cardiopulmonary support for periprocedural acute hemodynamic decompensation in patients undergoing catheter ablation of electrical storm

Andres Enriquez, Jackson Liang, Javier Gentile, Robert D. Schaller, Gregory E. Supple, David S. Frankel, Fermin C. Garcia, Joyce Wald, Edo Y. Birati, J. Eduardo Rame, Christian Bermudez, David J. Callans, Francis E. Marchlinski, Pasquale Santangeli

Research output: Contribution to journalArticlepeer-review

58 Scopus citations

Abstract

Background In patients with ventricular tachycardia or ventricular fibrillation (VT/VF) electrical storm (ES) undergoing catheter ablation (CA), hypotension due to refractory VT/VF, use of anesthesia, and cardiac stunning due to repeated implantable cardioverter-defibrillator shocks might precipitate acute hemodynamic decompensation (AHD). Objective We evaluated the outcomes of emergent cardiopulmonary support with extracorporeal membrane oxygenation (ECMO) to rescue AHD in patients undergoing CA of ES. Methods Between January 1, 2010 and December 31, 2016, 21 patients with ES (VT in 11 and premature ventricular complex–triggered VF in 10) were referred for CA and had periprocedural AHD requiring emergent ECMO support. Results In 14 patients, AHD occurred a mean of 1.5 ± 1.7 days before the procedure. In the remaining 7 patients, AHD occurred during or shortly after the procedure. ECMO was started successfully in all patients. Ablation was performed in 18 patients (9 with VF and 9 with VT). In patients with VF, premature ventricular complex suppression was achieved in 8 of 9 (89%). In those with VT, noninducibility was achieved in 7 of 9 (78%). After a median follow-up of 10 days, 16 patients died (13 during the index admission). Death was due to refractory VT/VF in 4 patients, heart failure in 11, and noncardiac cause in 1 patient. Seven patients survived beyond 6 months postablation; 5 remained free of VT/VF and 3 ultimately received a destination therapy (heart transplantation in 2 and left ventricular [LV] assist device in 1). Conclusion In patients with ES undergoing CA, the outcomes of ECMO support as rescue intervention for AHD are poor. The majority of these patients die of refractory heart failure in the short-term. Strategies to prevent AHD including preemptive use of hemodynamic support may improve survival.

Original languageEnglish
Pages (from-to)75-80
Number of pages6
JournalHeart Rhythm
Volume15
Issue number1
DOIs
StatePublished - Jan 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2017 Heart Rhythm Society

Funding

This research was supported in part by the Koegel Family Electrophysiology Research Fund.

FundersFunder number
Koegel Family Electrophysiology Research Fund

    Keywords

    • Catheter ablation
    • Electrical storm
    • Extracorporeal membrane oxygenation
    • Periprocedural acute hemodynamic decompensation
    • Ventricular tachycardia

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