Lü Fei, Eckman Peter M, Liao Kenneth K, Apostolidou Ioanna, John Ranjit, Chen Taibo, Das Gladwin S, Francis Gary S, Lei Han, Trohman Richard G, Benditt David G
University of Minnesota, Minneapolis, MN, USA.
Int J Cardiol. 2013 Oct 9;168(4):3859-65. doi: 10.1016/j.ijcard.2013.06.035. Epub 2013 Jul 15.
Catheter ablation of hemodynamically unstable ventricular tachycardia (VT) is possible with mechanical circulatory support (MCS), little is known regarding the relative safety and efficacy of different supporting devices for such procedures.
Sixteen consecutive patients (aged 63 ± 11 years with left ventricular ejection fraction of 20 ± 9%) who underwent ablation of hemodynamically unstable VT were included in this study. Hemodynamic support included percutaneous (Impella® 2.5, n = 5) and implantable left ventricular assist devices (LVADs, n = 6) and peripheral cardiopulmonary bypass (CPB, n = 5). Except for 2 Impella cases, hemodynamic support was adequate (with consistent mean arterial pressure of > 60 mmHg) to permit sufficient activation mapping for ablation. In the Impella and CPB groups, mean time under hemodynamic support was 185 ± 86 min, and time in VT was 78 ± 36 min. Clinical VT could be terminated at least once by ablation in all patients except 1 case with Impella due to hemodynamic instability. Peri-procedural complications included hemolysis in 1 patient with Impella and surgical intervention for percutaneous Impella placement problems in another 2. The median number of appropriately delivered defibrillator therapies was significantly decreased from 6 in the month before VT ablation to 0 in the month following ablation (p = 0.001).
Our data suggest that peripheral CPB and implantable LVAD provide adequate hemodynamic support for successful ablation of unstable VT. Impella® 2.5, on the other hand, was associated with increased risk of complications, and may not provide sufficient hemodynamic support in some cases.
在机械循环支持（MCS）下，对血流动力学不稳定的室性心动过速（VT）进行导管消融是可行的，但对于此类手术中不同支持设备的相对安全性和有效性知之甚少。
本研究纳入了16例连续接受血流动力学不稳定VT消融的患者（年龄63±11岁，左心室射血分数20±9%）。血流动力学支持包括经皮（Impella® 2.5，n = 5）和植入式左心室辅助装置（LVADs，n = 6）以及外周体外循环（CPB，n = 5）。除2例Impella病例外，血流动力学支持足够（平均动脉压持续> 60 mmHg），以允许进行足够的激动标测以进行消融。在Impella和CPB组中，血流动力学支持下的平均时间为185±86分钟，VT持续时间为78±36分钟。除1例因血流动力学不稳定使用Impella的患者外，所有患者的临床VT至少可通过消融终止一次。围手术期并发症包括1例使用Impella的患者发生溶血，另外2例因经皮放置Impella出现问题而进行手术干预。适当的除颤治疗中位数从VT消融前一个月的6次显著降至消融后一个月的0次（p = 0.001）。
我们的数据表明，外周CPB和植入式LVAD为成功消融不稳定VT提供了足够的血流动力学支持。另一方面，Impella® 2.5与并发症风险增加相关，并且在某些情况下可能无法提供足够的血流动力学支持。
