TY - JOUR
T1 - Outcomes with prophylactic use of percutaneous left ventricular assist devices in high-risk patients undergoing catheter ablation of scar-related ventricular tachycardia
T2 - A propensity-score matched analysis
AU - Muser, Daniele
AU - Liang, Jackson J.
AU - Castro, Simon A.
AU - Hayashi, Tatsuya
AU - Enriquez, Andres
AU - Troutman, Gregory S.
AU - McNaughton, Nelson W.
AU - Supple, Gregory
AU - Birati, Edo Y.
AU - Schaller, Robert
AU - Garcia, Fermin C.
AU - Frankel, David S.
AU - Dixit, Sanjay
AU - Callans, David J.
AU - Zado, Erica S.
AU - Marchlinski, Francis E.
AU - Santangeli, Pasquale
N1 - Publisher Copyright:
© 2018 Heart Rhythm Society
PY - 2018/10
Y1 - 2018/10
N2 - 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.
AB - 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.
KW - Acute hemodynamic decompensation
KW - Catheter ablation
KW - Heart failure
KW - Heart transplant
KW - Mortality
KW - Percutaneous left ventricular assist device
KW - Ventricular tachycardia
UR - http://www.scopus.com/inward/record.url?scp=85054091866&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2018.04.028
DO - 10.1016/j.hrthm.2018.04.028
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
C2 - 29753944
AN - SCOPUS:85054091866
SN - 1547-5271
VL - 15
SP - 1500
EP - 1506
JO - Heart Rhythm
JF - Heart Rhythm
IS - 10
ER -