Outcomes with prophylactic use of percutaneous left ventricular assist devices in high-risk patients undergoing catheter ablation of scar-related ventricular tachycardia: A propensity-score matched analysis

Daniele Muser, Jackson J. Liang, Simon A. Castro, Tatsuya Hayashi, Andres Enriquez, Gregory S. Troutman, Nelson W. McNaughton, Gregory Supple, Edo Y. Birati, Robert Schaller, Fermin C. Garcia, David S. Frankel, Sanjay Dixit, David J. Callans, Erica S. Zado, Francis E. Marchlinski, Pasquale Santangeli

Research output: Contribution to journalArticlepeer-review

51 Scopus citations

Abstract

Background: The PAINESD score predicts the risk of periprocedural acute hemodynamic decompensation (AHD) and postprocedural mortality in patients undergoing catheter ablation (CA) of scar-related ventricular tachycardia (VT). The role of prophylactic placement of percutaneous left ventricular assist devices (pLVADs) in high-risk patients is unknown. Objective: The purpose of this study was to evaluate the outcomes of prophylactic use of pLVAD in high-risk patients undergoing CA of scar-related VT. Methods: We included 75 patients undergoing CA of scar-related VT in whom a prophylactic pLVAD was implanted because of perceived high risk. The control population was a propensity-matched group of 75 patients who did not undergo prophylactic pLVAD placement. The PAINESD score was used for propensity matching. Results: The median PAINESD score was 13 (41% with score ≥15) in the prophylactic pLVAD group and 12 (40% with score ≥15) in the control group. Periprocedural AHD occurred in 5 patients (7%) in the prophylactic pLVAD group and in 17 patients (23%) in the control group (P <.01). The 12-month cumulative incidence of VT was 40% in the prophylactic pLVAD group vs 41% in the control group (P =.97), while the 12-month incidence of death/transplant was 33% vs 66%, respectively (P <.01). In multivariable analysis, left ventricular ejection fraction (HR 0.97, 95% CI 0.95–0.99, P =.03), chronic kidney disease (HR 2.24, 95% CI 1.35–3.72, P <.01), VT recurrence (HR 2.33, 95% CI 1.31–4.14, P <.01), and prophylactic pLVAD (HR 0.28, 95% CI 0.16–0.49, P <.01) were all independently associated with death/transplant. Conclusion: Prophylactic pLVAD placement in high-risk patients undergoing CA of scar-related VT is associated with a reduced risk of AHD and death/transplant during follow-up without affecting VT-free survival.

Original languageEnglish
Pages (from-to)1500-1506
Number of pages7
JournalHeart Rhythm
Volume15
Issue number10
DOIs
StatePublished - Oct 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2018 Heart Rhythm Society

Keywords

  • Acute hemodynamic decompensation
  • Catheter ablation
  • Heart failure
  • Heart transplant
  • Mortality
  • Percutaneous left ventricular assist device
  • Ventricular tachycardia

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