scholarly journals Catheter ablation supported by extracorporeal membrane oxygenation -last resort treatment of arrhythmic storm?

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Costa ◽  
F Amador ◽  
J Calvao ◽  
G Pestana ◽  
A Lebreiro ◽  
...  
Keyword(s):  
Heart Disease ◽  
Catheter Ablation ◽  
Left Ventricle ◽  
Extracorporeal Membrane Oxygenation ◽  
High Mortality ◽  
Structural Heart Disease ◽  
Ecmo Support ◽  
Vt Ablation ◽  
Va Ecmo

Abstract Introduction Arrhythmic storm (AS) is associated with high mortality, even with best medical care and hemodynamic support. If medical therapeutic failure, electrophysiological mapping and ablation are potential lifesaving therapies. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides temporary mechanical circulatory support and can be used as a salvage intervention in patients with cardiogenic shock. Considering the seriousness of AS and the technical complexity involved, catheter ablation supported by VA-ECMO is infrequently performed. We sought to assess the safety and effectiveness of emergent catheter ablation procedures performed in patients on VA-ECMO at our hospital. Methods Retrospective study of all ventricular tachycardia (VT) catheter ablation procedures performed with VA-ECMO support at a tertiary centre between 2016 and 2020. Follow-up data was obtained from review of electronical records. Results Five patients underwent 6 emergent VT ablation procedures due to AS. The median age was 62 years (range, 52) and 4 patients were men. Three patients had VT at admission, while 2 were admitted with an acute coronary syndrome and developed VT during the hospitalization. Four patients had ischemic heart disease, though only 1 had previous history of VT; the remaining patient presented no structural heart disease. Median left ventricle ejection fraction was 11% (range 30). All patients had incomplete response to amiodarone, lidocaine or overdrive pacing, before being proposed to catheter ablation. Four patients were on ECMO support before ablation, while 1 was cannulated during the procedure due to hemodynamic instability. Ablation was performed using a retrograde approach in 3 patients, and combined retrograde and transeptal access in 2; one patient had epicardial ablation after unsuccessful endovascular approach. Three patients had left ventricle substrate ablation and the remaining 2 of the right ventricle. No major complications were seen directly related to the procedures. The median length of stay in intensive care unit was 22 days (range 41 days). Weaning of VA-ECMO was accomplished in all patients. Two patient died during the same hospitalization (one due to uncontrolled arrhythmic events). At a median 23 months (range 31) of follow-up of the surviving patients, two had recurrence of VT but no one had return of AS. Conclusion In our sample VT ablation on VA-ECMO support was a safe procedure, with no immediate complications. However, as reported in the literature, a high mortality rate was observed both in-hospital and during follow-up, mostly related to advanced structural heart disease. Also, considerable VT recurrence rates were seen, but with no re-hospitalization. Our experience shows that catheter ablation is a life-saving procedure in otherwise uncontrollable AS and allowed absolute success in weaning VA-ECMO. FUNDunding Acknowledgement Type of funding sources: None.

5207Bilateral cardiac sympathetic denervation in structural heart disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Dusi ◽  
L Pugliese ◽  
I Passarelli ◽  
R Camporotondo ◽  
M Driussi ◽  
...  
Keyword(s):  
Heart Disease ◽  
Nyha Class ◽  
Case Series ◽  
Structural Heart Disease ◽  
Median Number ◽  
Sympathetic Denervation ◽  
Icd Shock ◽  
Vt Ablation ◽  
Cardiac Sympathetic Denervation

Abstract Background Left cardiac sympathetic denervation (LCSD) is an established therapy for refractory ventricular arrhythmias (VAs) in channelopathies. A multicentric American and Indian case series suggested a greater efficacy of bilateral denervation (BCSD) in patients with structural heart disease (SHD). Purpose To describe our single-center experience with BCSD in SHD. Methods Nine patients (78% male, mean 55±18 yrs, mean LVEF 31±14%) with SHD and refractory VAs underwent BCSD. All had a Video-Assisted Thoracoscopic Surgery (VATS), in 2 cases associated with the robotic technique. The underlying cardiomyopathy (CMP) was non-ischemic (NICMP) in most cases (n=5, 55%), ischemic in 2 cases, arrhythmogenic right ventricular (ARVC) in one and related to lamin A/C deficiency in one. All patients had an ICD, 44% (n=4) a CRT-D. NYHA functional class I was present in 4 patients, the rest were in NYHA class II (n=3) or III (n=2). Three patients were candidates to heart transplant/LV assistance device. The arrhythmic burden pre BCSD included in 7 pts (78%) a history of electrical storm (ES); the median number of shocks/patient in the 12 months before BCSD was 5 (IQ range 3–18). Except for 2 patients with previous thyrotoxicosis, the remaining were either on amiodarone (n=6) or on sotalol (n=1) before BCSD. Main BCSD indications were represented by drug refractory fast VT in 7 pts (cycle <250 msec) and by recurrent monomorphic VT episodes (mean cycle 351 msec) after endocardial VT ablation in 2 patients. Results No major complication occurred. One patient (NICMP, NYHA II), has an uneventful follow up (FU) of less than 1 month and was excluded from the efficacy analysis. The median FU in the remaining 8 patients is 10 months (IQ range 6–19), during which the median number of shocks/patients was 0.5 (IQ range 0–3). Overall, 4 patients (50%) had ICD shock recurrences. Two cases (mean LVEF 17.5%, NYHA class III) had an ES during severe hemodynamic instability and subsequently died because of cardiogenic shock respectively 1 and 7 months after BCSD. One case had three, not consecutive ICD shocks 20 months after BCSD in the setting of severe amiodarone-induced thyrotoxicosis. Finally, one patient received a single intra-hospital ICD shock 5 days after BCSD before reintroduction of full-dose beta-blockers. The figure summarizes ICD shocks burden in the 6 months before and after BCSD. Among the 5 patients with NICMP/ARVC (4 in NYHA class I), only 1 had a single ICD shock recurrence. ICD shocks pre versus post BCSD, n=8 Conclusions Our case series, although numerically small, has a good follow-up and is the first reported in Europe. The results are in agreement with the suggested remarkable efficacy of BCSD in patients with good functional capacity and fast VAs. Therefore, cardiac sympathetic denervation should always be considered in patients with SHD and refractory ventricular tachyarrhythmias, especially in case VT ablation is either not indicated or fails.

scholarly journals Clinical outcomes of postoperative extracorporeal membrane oxygenation support in Stanford type a aortic dissection

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fudong Fan ◽  
Qing Zhou ◽  
Jun Pan ◽  
Hailong Cao ◽  
Kai Li ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Extracorporeal Membrane Oxygenation ◽  
Clinical Outcomes ◽  
Type A ◽  
Ecmo Support ◽  
Type A Aortic Dissection ◽  
Membrane Oxygenation ◽  
Va Ecmo ◽  
Support Time

Abstract Background Extracorporeal membrane oxygenation (ECMO) support may be considered to reduce mortality but survival and clinical outcomes are uncertain after Stanford type A Aortic dissection (TAAD). We analyzed the data of TAAD patients with postoperative ECMO support in our institution to investigate clinical outcomes. Methods In this retrospective cohort study, all clinical data of TAAD patients with postoperative ECMO support from January 2013 to October 2019 in our institution were harvested. Cases with redo or incomplete records were excluded. Results 22 cases were enrolled, 18 male and 4 female. The mean age was52.85±10.91 years. 20 patients underwent VA-ECMO treatment and 2 patients received VV-ECMO support. The support time was92.54±78.71 hours. 9 patients were successfully weaned from ECMO. 30-day in-hospital survival rate was 27.27 % (6/22). The follow-up duration is from 5 to 74 months. The median follow-up time is 35 months. Only four patients were still alive at the end of the follow-up period. Conclusions The mortality of TAAD patients with postoperativesevere circulatory and respiratory dysfunctions is high. ECMO would be considered as a valuable contribution to save lives. But more experience needs to be accumulated to improve clinical outcome.

scholarly journals Recurrence of atrial fibrillation after successful radiofrequency catheter ablation of accessory pathway in patients with Wolff-Parkinson-White syndrome

2010 ◽  
Vol 138 (3-4) ◽  
pp. 170-176
Author(s):  
Nebojsa Mujovic ◽  
Miodrag Grujic ◽  
Stevan Mrdja ◽  
Aleksandar Kocijancic ◽  
Bosiljka Vujisic-Tesic ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Catheter Ablation ◽  
Accessory Pathway ◽  
Structural Heart Disease ◽  
Older Age ◽  
First Year ◽  
Symptomatic Recurrence ◽  
Af Recurrence

Introduction. Paroxysmal atrial fibrillation (AF) occurs in 11.5-39% of the patients with Wolff-Parkinson-White (WPW) syndrome and frequently, but not always, disappears after successful accessory pathway (AP) ablation. Objective. To determine AF recurrence rate, time to AF recurrence and predictors of AF recurrence after radiofrequency (RF) catheter-ablation of AP in WPW-patients with AF. Methods. Data from 245 consecutive patients with WPW-syndrome who underwent RF catheter-ablation of AP were analyzed. A total of 52 patients (43 men, mean age: 42.5?14.1 years) with preablation history of spontaneous AF were followed up after definitive AP ablation. At baseline, structural heart disease and comorbidities were diagnosed in 19.2% and 21.2% of the patients, respectively. Results. During the follow-up of 5.2?3.7 years, 3 patients (5.7%) died; one of these patients, previously known for recurrent AF, died from ischaemic stroke. Symptomatic recurrence of AF was detected in 9 of 52 patients (17.3%). In 66.7% of these patients, AF recurrence was identified in the first year following the procedure. Kaplan-Meier analysis demonstrated that freedom from recurrent AF after 3 months was 94.2%, after 1 year 87.5% and after 4 years 84.3%. Univariate analysis showed that older age (p=0.023), presence of structural heart disease (p=0.05) and dilated left atrium (p=0.013) were significantly related to AF recurrence. However, using multivariate Cox regression, older age was the only independent predictor of AF recurrence (HR=2.44 for every life decade; p=0.006). Analysis of ROC curves showed that, after the age of 36, the risk of AF recurrence abruptly increased. Conclusion. Symptomatic recurrence of AF was detected in 17% of WPW-patients after definite RF ablation of AP. The timedependent occurrence of AF recurrences and age-dependent increase in the rate of AF recurrence were identified. Closer follow-up and/or extension of drug therapy in older patients, at least in the first year after the procedure, seem prudent.

scholarly journals Interaction between veno-arterial extracorporeal membrane oxygenation and the right ventricle

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
EP Elena Puerto ◽  
GT Guido Tavazzi ◽  
AG Alessia Gambaro ◽  
CC Chiara Cirillo ◽  
AP Alessandro Pecoraro ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Extracorporeal Membrane Oxygenation ◽  
Right Ventricle ◽  
Outflow Tract ◽  
Ecmo Support ◽  
Ventricular Failure ◽  
Membrane Oxygenation ◽  
Va Ecmo ◽  
The Right ◽  
Rv Function

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Fundación Alfonso Martín Escudero The response of the right ventricle (RV) to the hemodynamic effects of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is unpredictable. We hypothesized if presence of uni- or bi-ventricular failure before implantation and cannulation strategy may influence. We assessed RV performance during VA-ECMO support and identify RV-related predictors of weaning.  Methods. Changes of RV size and function during VA-ECMO by echocardiography were retrospectively analyzed in 87 patients. Predictors of weaning were evaluated by logistic regression. Results. RV echocardiographic parameters did not vary significantly during VA-ECMO, neither after stratification by cannulation type or presence of isolated or biventriular failure. Succesful weaning was conditioned by absence of RV dysfunction before implantation (OR 14.7,95%CI 13.3-140.3;p = 0.025) or in the last day of support (OR 9.5; 95%CI 1.6-54;p = 0.011) and was favored by a total or partial recovery of RV function during the assistance (OR 6.2; 95%CI 1.7-22.4;p = 0.005). RV improvement was more often observed in patients with acute RV failure, while VA-ECMO configuration had no effect. Conclusions. Preservation or improvement of RV function during VA-ECMO support is essential for weaning. RV echocardiographic performance does not change significantly during VA-ECMO  and is not influenced by cannulation type or presence of uni- or bi-ventricular failure before implantation. Echo parameters evolution during VA-ECMOPre-ECMO&lt; 24h on ECMO&gt; 24h on ECMOpNn = 68n = 68n = 63LV diastolic diameter, mm (mean ± SD)53.34 ± 15.5954.86 ± 13.8956.18 ± 14.620.317LV systolic diameter, mm45.28 ± 11.6745.17 ± 14.5846.07 ± 15.590.963LVEF, n (%)20 (10-38.75)17.5 (10-30)25 (10-40)0.102RV basal diameter, mm (mean ± SD)41.05 ± 9.7938.92± 9.1740.05 ± 9.560.484RV systolic disfunction, n (%)65 (95.6)65 (95.5)43 (68.2)0.073Tricuspid regurgitation, n (%)50 (73.4)37 (54.3)49 (77.8)0.146Pulmonary systolic pressure, mmHg (mean ± SD)41.54 ± 24.1339.09 ± 20.2445.29 ± 25.730.783Aortic regurgitation, n (%)47 (69.1)39 (57.4)35 (55.5)0.775Mitral regurgitation, n (%)64 (94.1)48 (70.5)44 (69.8)0.591Dd diastolic diameter; EF: ejection fraction; LV: left ventricle; LVOT: left ventricle outflow tract; RV: right ventricle; RVOT: right ventricle outflow tract; VTI: velocity time integralAbstract Figure. Right ventricular function predictors

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