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Prophylactic mechanical circulatory support for protected ventricular tachycardia ablation: A meta‐analysis of the literature
Author(s) -
Mariani Silvia,
Napp L. Christian,
Kraaier Karin,
Li Tong,
Bounader Karl,
Hanke Jasmin S.,
Dogan Günes,
Schmitto Jan D.,
Lorusso Roberto
Publication year - 2021
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.13945
Subject(s) - medicine , impella , confidence interval , odds ratio , decompensation , ablation , ventricular tachycardia , tachycardia , meta analysis , surgery , cardiology , ventricular assist device , heart failure
Acute hemodynamic decompensation (AHD) during ventricular tachycardia (VT) ablation occurs in about 11% of cases. Prophylactic use of temporary mechanical circulatory support (pro‐tMCS) has been applied to prevent AHD during VT ablation, but evidence supporting this practice is still lacking. This systematic review and meta‐analysis assessed the procedural characteristics and outcomes of pro‐tMCS for VT ablation. PubMed/Medline was screened until February 2020. Articles including adults receiving pro‐tMCS for VT ablation were included, and a meta‐analysis to compare proMCS and no‐tMCS was performed. Primary outcome was in‐hospital/30‐day mortality. Five observational studies presenting 400 procedures (pro‐tMCS: n = 187; no‐tMCS: n = 213) were included. Baseline characteristics were comparable between groups. Impella and TandemHeart were used in 86.6% and 13.4% of cases, respectively. In the pro‐tMCS group, more VTs were induced (mean difference: 0.52, confidence interval [CI]: 0.26‐0.77, P < .0001), and patients remained in VT on average for 24.04 minutes longer (CI: 18.28‐29.80, P < .00001). Procedural success was comparable between groups, as was VT recurrence. Pro‐tMCS patients had an odds ratio of 0.55 (CI: 0.28‐1.05, P = .07) for in‐hospital/30‐day mortality and 0.55 (CI: 0.32‐0.94, P = .03) for mortality at follow‐up. Sixty‐four percent of no‐tMCS patients received rescue tMCS. The most common tMCS‐related complications were bleeding events. Pro‐tMCS allowed for a prolonged time on VTs and the induction of more VTs. Although these advantages were not associated with differences in procedural success, VT recurrence, or in‐hospital/30‐day mortality in the overall population, pro‐tMCS might improve long‐term survival. Further prospective studies are urgently needed to confirm these results.