Dusik Milan, Havranek Stepan, Rob Daniel, Simek Jan, Valek Martin, Fingrova Zdenka, Boucek Tomas, Pudil Jan, Linhart Ales, Belohlavek Jan
2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
Institute for Heart Diseases, Wroclaw Medical University, Wrocław, Poland.
PLoS One. 2025 Sep 15;20(9):e0332597. doi: 10.1371/journal.pone.0332597. eCollection 2025.
Short-term mechanical circulatory supports (MCS) are used to stabilize patients with severe cardiogenic shock (CS). Catheter ablation may be an option to suppress recurrent arrhythmias preventing MCS weaning. We retrospectively analysed a dedicated registry to identify CS patients who underwent a catheter ablation between January 2020 and August 2024 for treatment resistant and hemodynamically significant arrhythmias while being on the MCS. Patients with supraventricular and ventricular tachycardias (SVT/VT) were analysed separately. Nine patients (8 males, 69 [IQR 60;74] years) were ablated for a refractory VT. Impella CP was used in 6 patients, VA ECMO in 2 patients, and 1 patient was on ECPELLA. Seven patients (78%) were successfully weaned off the MCS after the catheter ablation. 3 patients (33%) died within 30 days. The arrhythmia recurred in 5 patients (56%). Significant complications of MCS were reported in 6 patients (66%). The catheter ablation was complicated in one patient. SVT ablation was performed in 4 patients (3 males, 73 [IQR 67; 78] years, 1x VA ECMO, 2x Impella CP, 1x Impella 5.5). Three patients with atrial fibrillation were treated by a non-selective AV node ablation (pace and ablate strategy). One patient underwent an ablation of focal atrial tachycardia. The MCS was successfully explanted in all patients and no patient died in 30 days. The MCS use was complicated in one patient. Catheter ablation of refractory arrhythmias in CS patients treated by MCS is a safe and feasible approach to facilitate the MCS weaning process.
短期机械循环支持（MCS）用于稳定严重心源性休克（CS）患者的病情。导管消融可能是抑制复发性心律失常、防止MCS撤机的一种选择。我们回顾性分析了一个专门的注册数据库，以确定在2020年1月至2024年8月期间接受导管消融治疗的CS患者，这些患者在接受MCS治疗时存在抗药且血流动力学显著的心律失常。室上性和室性心动过速（SVT/VT）患者分别进行分析。9例患者（8例男性，年龄69 [四分位间距60；74]岁）因难治性室性心动过速接受了消融治疗。6例患者使用了Impella CP，2例患者使用了VA ECMO，1例患者使用了ECPELLA。7例患者（78%）在导管消融后成功撤掉了MCS。3例患者（33%）在30天内死亡。5例患者（56%）心律失常复发。6例患者（66%）报告了MCS的严重并发症。1例患者的导管消融出现并发症。4例患者（3例男性，年龄73 [四分位间距67；78]岁，1例使用VA ECMO，2例使用Impella CP，1例使用Impella 5.5）进行了SVT消融。3例心房颤动患者接受了非选择性房室结消融（起搏和消融策略）。1例患者接受了局灶性房性心动过速消融。所有患者的MCS均成功移除，30天内无患者死亡。1例患者的MCS使用出现并发症。对接受MCS治疗的CS患者进行难治性心律失常的导管消融是促进MCS撤机过程的一种安全可行的方法。
